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The Language of Medicine
TWELFTH EDITION
Davi-Ellen Chabner BA, MAT
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Table of Contents
Instructions for online access
Cover image
Title Page
Copyright
Dedication
Preface
WELCOME TO THE 12TH EDITION OF THE LANGUAGE
OF MEDICINE
NEW TO THE 12TH EDITION
HOW TO USE THE BOOK
ALSO AVAILABLE
Acknowledgments
Reviewers
Chapter 1 Basic Word Structure
Objectives in Studying the Medical Language
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Word Analysis
Exercises
Answers to Exercises
Chapter 2 Terms Pertaining to the Body as a Whole
Structural Organization of the Body
Abdominopelvic Regions and Quadrants
Divisions of the Back (Spinal Column)
Positional and Directional Terms
Planes of the Body
Exercises
Answers to Exercises
Chapter 3 Suffixes
Introduction
A Closer Look
Exercises
Answers to Exercises
Chapter 4 Prefixes
Introduction
A Closer Look
Exercises
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Answers to Exercises
Chapter 5 Digestive System
Introduction
Anatomy and Physiology
Pathology of the Digestive System
Pathologic Conditions
Exercises
Answers to Exercises
Chapter 6 Additional Suffixes and Digestive System Terminology
Introduction
Laboratory Tests and Clinical Procedures
Exercises
Answers to Exercises
Chapter 7 Urinary System
Introduction
Anatomy of the Major Organs
Physiology: How the Kidneys Produce Urine
Urinalysis
Pathologic Terminology: Kidney, Bladder, and Associated
Conditions
Laboratory Tests and Clinical Procedures
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Exercises
Answers to Exercises
Chapter 8 Female Reproductive System
Introduction
Organs of the Female Reproductive System
Menstruation and Pregnancy
Pathology: Gynecologic, Breast, Pregnancy, and Neonatal
Clinical Tests and Procedures
Exercises
Answers to Exercises
Chapter 9 Male Reproductive System
Introduction
Anatomy
Pathologic Conditions; Sexually Transmitted Infections
Laboratory Tests and Clinical Procedures
Exercises
Answers to Exercises
Chapter 10 Nervous System
Introduction
General Structure of the Nervous System
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Neurons, Nerves, and Glial Cells
The Brain
The Spinal Cord and Meninges
Pathology
Laboratory Tests and Clinical Procedures
Exercises
Answers to Exercises
Chapter 11 Cardiovascular System
Introduction
Blood Vessels and the Circulation of Blood
Anatomy of the Heart
Physiology of the Heart
Blood Pressure
Pathology: the Heart and Blood Vessels
Laboratory Tests and Clinical Procedures
Exercises
Answers to Exercises
Chapter 12 Respiratory System
Introduction
Anatomy and Physiology of Respiration
Pathology
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Clinical Procedures
Exercises
Answers to Exercises
Chapter 13 Blood System
Introduction
Composition and Formation of Blood
Blood Types
Blood Clotting
Pathology
Laboratory Tests and Clinical Procedures
Exercises
Answers to Exercises
Chapter 14 Lymphatic and Immune Systems
Introduction
Lymphatic System
Immune System
Pathologic Conditions
Laboratory Tests and Clinical Procedures
Exercises
Answers to Exercises
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Chapter 15 Musculoskeletal System
Introduction
Bones
Pathology—Bones
Joints
Pathology—Joints
Muscles
Pathology—Muscles
Laboratory Tests and Clinical Procedures
Exercises
Answers to Exercises
Chapter 16 Skin
Introduction
Anatomy of the Skin
Accessory Structures of the Skin
Pathology
Laboratory Tests and Clinical Procedures
Exercises
Answers to Exercises
Chapter 17 Sense Organs
Introduction
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The Eye
Errors of Refraction
Pathology—the Eye
Clinical Procedures—the Eye
The Ear
Pathology—the Ear
Clinical Procedures—the Ear
Exercises
Answers to Exercises
Chapter 18 Endocrine System
Introduction
Thyroid Gland
Parathyroid Glands
Adrenal Glands
Pancreas
Pituitary Gland
Ovaries
Testes
Pathology
Laboratory Tests
Clinical Procedures
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Exercises
Answers to Exercises
Chapter 19 Cancer Medicine (Oncology)
Introduction
Characteristics of Tumors
Carcinogenesis
Classification of Cancerous Tumors
Pathologic Descriptions
Grading and Staging Systems
Cancer Treatment
Laboratory Tests
Clinical Procedures
Exercises
Answers to Exercises
Chapter 20 Radiology and Nuclear Medicine
Introduction
Radiology
Nuclear Medicine
Exercises
Answers to Exercises
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Chapter 21 Pharmacology
Introduction
Drug Names, Standards, and References
Administration of Drugs
Drug Actions and Interactions
Drug Toxicity
Classes of Drugs
Exercises
Answers to Exercises
Chapter 22 Psychiatry
Introduction
Psychiatric Clinical Symptoms
Psychiatric Disorders
Therapeutic Modalities
Exercises
Answers to Exercises
Mini-Dictionary
A
B
C
D
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E
F
G
H
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J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
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Glossary
Appendix I Plurals
Appendix II Abbreviations, Acronyms, Eponyms, and Symbols
Abbreviations
Acronyms
Eponyms
Symbols
Appendix III Normal Hematologic Reference Values and
Implications of Abnormal Results
Appendix IV Drugs
Illustrations Credits
Index
Chabner makes medical terminology MEMORABLE…
Students…
Instructors…
Order Now!
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Copyright
THE LANGUAGE OF MEDICINE, TWELFTH EDITION ISBN:
978-0-323-55147-2
Copyright © 2021, Elsevier Inc. All rights reserved.
No part of this publication may be reproduced or transmi ed in
any form or by any means, electronic or mechanical, including
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system, without permission in writing from the publisher. Details
on how to seek permission, further information about the
Publisher's permissions policies and our arrangements with
organizations such as the Copyright Clearance Center and the
Copyright Licensing Agency, can be found at our website:
www.elsevier.com/permissions.
This book and the individual contributions contained in it are
protected under copyright by the Publisher (other than as may be
noted herein).
Notice
Practitioners and researchers must always rely on their own
experience and knowledge in evaluating and using any
information, methods, compounds or experiments described
herein. Because of rapid advances in the medical sciences, in
particular, independent verification of diagnoses and drug
dosages should be made. To the fullest extent of the law, no
responsibility is assumed by Elsevier, authors, editors or
contributors for any injury and/or damage to persons or property
as a ma er of products liability, negligence or otherwise, or from
any use or operation of any methods, products, instructions, or
ideas contained in the material herein.
Previous editions copyrighted 2017, 2014, 2011, 2007, 2004, 2001,
1996, 1991, 1985, 1981, and 1976.
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Library of Congress Control Number: 2020932476
Senior Content Strategist: Linda Woodard
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Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
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Dedication
For Gus, Amari, Solomon, Bebe, Ben, and Louisa
You make it all worthwhile.
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Preface
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WELCOME TO THE 12TH EDITION OF
THE LANGUAGE OF MEDICINE
The continuing focus of this new edition is its cu ing-edge relevance to
real-life medical practice. Drawing on the newest technology, state-ofthe-art medical procedures, and treatments, The Language of Medicine
brings medical terminology to life. The newly-drawn dynamic images
and up-to-date photography plus compelling patient stories further
illustrate medical terminology in action.
I am honored that this text continues to be the book instructors return
to, year after year, because their students tell them that it works! As a
student, you will find that The Language of Medicine speaks to you no
ma er what your background or level of education. It is wri en in
simple, non-technical language that creates an exceptionally accessible
pathway to learning. Since it is a workbook-text combination, you
engage and interact on practically every page through writing and
reviewing terms, labeling diagrams, and answering questions.
Terminology is explained so that you understand medical terms in their
proper context, which is the structure and function of the human body
in health and disease.
Throughout the process of writing this text over its 12 editions, I have
listened to hundreds of students and instructors and incorporated their
insightful suggestions. Expert medical reviewers have once again
helped me to ensure that the terminology included reflects cu ing edge
clinical practice. New information and illustrations throughout are the
result of recommendations from all those who have so generously
provided feedback. My continuing goal in writing The Language of
Medicine is to help you not only learn medical terminology but also to
enjoy learning! You will find that medical terminology comes alive and
stays with you when you use my interactive, logical, and easy-to-follow
method. Undeniably, the study of this language requires commitment
and hard work, but the benefits are great. Knowledge of medical
terminology will give you a strong start in your career.
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NEW TO THE 12TH EDITION
The biggest bonus for students and instructors is the brand new MINIDICTIONARY at the end of the book. This is a complete list of all
medical terms in the text with easy to understand explanations. My
thought was to provide an immediate, convenient way for finding
definitions, seeing pronunciations, and checking answers to all
terminology sections. It also will be a useful reference, not only during
your coursework, but as you begin your new medical career!
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While the essential elements of The Language of Medicine remain in
place, the new 12th edition is even more relevant to real-life medical
situations.
The 12th edition includes helpful hints to point out important facts
and make things clear. There are also new, first-hand stories of medical
conditions and procedures. These personal accounts make medical
terminology more understandable and relevant.
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HOW TO USE THE BOOK
The Language of Medicine makes learning easy. The book guides and
coaches you step by step through the learning experience. Don't get
overwhelmed! Approach learning systematically, step by step. I've
helped you study each chapter by organizing the information in small
pieces. Icons are provided to help you navigate the sections of the text.
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ALSO AVAILABLE
Student Evolve Resources (complimentary
access included with purchase of this text)
The student website accompanying this new edition is packed with
activities, games, additional information, and video clips to expand
your understanding and test your knowledge. Additionally, on the
website, you can hear the terms corresponding to the Pronunciation of
Terms section in each chapter (more than 3,000 terms in all). Access
your resources at: h p://evolve.elsevier.com/Chabner/language.
MEDICAL LANGUAGE INSTANT TRANSLATOR (for
sale separately)
The Medical Language Instant Translator is a uniquely useful resource
for all allied health professionals and students of medical terminology.
It is a pocket-sized medical terminology reference with convenient
information at your fingertips!
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INSTRUCTOR'S RESOURCE MANUAL
The Language of Medicine Instructor's Resource Manual (includes
instructor's manual, ExamView test bank, PowerPoints, and an image
collection) is available with even more new quizzes, teaching
suggestions, crossword puzzles, medical reports, and reference
material. The image collection contains all figures and photos from the
12th edition. The instructor materials plus a test bank can be accessed
online at h p://evolve.elsevier.com/Chabner/language.
The fundamental features you have come to trust in learning and
teaching medical terminology remain strong in this new edition. These
are:
• Simple, nontechnical explanations of medical
terms.
• Workbook format with ample space to write
answers.
• Explanations of clinical procedures, laboratory
tests, and abbreviations related to each body
system.
• Pronunciation of Terms sections with phonetic
spellings and spaces to write meanings of terms.
• Practical Applications sections with case reports,
operative and diagnostic tests, and laboratory and
x-ray reports.
• Exercises that test your understanding of
terminology as you work through the text step by
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step (answers are included).
• Review Sheets that pull together terminology to
help you study.
• Comprehensive glossaries and appendices for
reference in class and on the job.
Each student and teacher who selects The Language of Medicine
becomes my partner in the exciting adventure of learning medical
terms. Continuity is crucial. Continue to communicate with me through
email (daviellenchabner@gmail.com) with your suggestions and
comments so that future printings and editions may benefit. A website
connected to The Language of Medicine and dedicated to helping students
and teachers is located at h p://evolve.elsevier.com/Chabner/language.
I hope you will tell me about additional resources you would like to see
on that website so that we can make it an even more useful part of the
learning process. You should know that I still experience the thrill and
joy of teaching new students. I love being in a classroom and feel
privileged to continue to write this text. I hope that my enthusiasm and
passion for the medical language are transmi ed to you through these
pages.
Work hard, but have fun with The Language of Medicine!
DAVI-ELLEN CHABNER
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Acknowledgments
Maureen Pfeifer has been my extraordinary and indispensable
editorial partner for the last 22 years. Her phenomenal expertise in
all facets of communication, coordination, production, editing,
updating, and management is amazing. She has the unique ability
to “make things happen” and “make things right.” Both
personally and professionally, I am grateful for her unique insight
and capabilities. She is intelligent, calm, and upbeat in the face of
any issue affecting The Language of Medicine and its ancillaries.
Most of all, I rely on her loyalty and her confidence that we are
creating an eminently useful and valuable textbook and resource
for both students and instructors. Thank you, Maureen, for
everything you do for me, especially when you take things “off
my plate.”
Bruce A. Chabner, MD, and Elizabeth Chabner Thompson, MD,
MPH, continue to be amazing resources to me for expert and upto-date medical advice. Their contributions were essential in
reviewing and editing all chapters and glossaries. My devoted
friend, Dan Longo, MD, never turned me down for valuable
medical advice and editing of chapters. He was also a wonderful
resource for helping identify expert reviewers.
Jim Perkins, Assistant Professor of Medical Illustration,
Rochester Institute of Technology, has been associated with The
Language of Medicine since its 6th edition. He has worked with me
to create drawings that are not only a ractive but also essential in
making the terminology more understandable. I have come to rely
on his unique talent for clarity, accuracy, and detail.
I am indebted to the many medical reviewers listed on pages
xv-xvi who offered essential advice and comments on specific
chapters. Their insights and expertise make this 12th edition
reflect what is current, accurate, and cu ing edge in medicine
today.
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The classroom instructors listed on pages xvi-xvii extensively
and carefully reviewed the text, and I have listened to their
comments, which are integrated into this new edition. Many other
instructors contacted me personally through email with helpful
suggestions.
I am always pleased to hear from students who comment on the
book and ask important questions. I try to answer each as quickly
and accurately as possible. Thanks to Shulamit Izen, Vashine
Kamesan, Stephanie Kitchingham, Alfred Kyrollos, Rachel
Recolcolin, Megan Peterson, Christina Sastre, Julia Sjoquist,
Victoria Swanson, and Lan Wang.
The In Person stories throughout the text are first-hand personal
accounts of individuals dealing with illness and medical
procedures. The writers of these stories are extraordinarily
generous to share their insights and reactions so that we all
benefit. A very special thank you to: Stan Ber, Nancy J.
Brandwein, Mary Braun, Bruce A. Chabner, Lenore Estrada, Sidra
DeKoven Ezrahi, Elizabeth F. Fideler, Tanzie Johnson, Kevin
Mahoney, Frank McGinnis, Brenda Melson, John Melson, John
Murphy, Laura Claridge Oppenheimer, Carolyn Peter, Bob Rowe,
Ruthellen Sheldon, Elizabeth Chabner Thompson, Cathy Ward,
and Kemisha White.
The superb staff at Elsevier Health Sciences continues to be vital
to the success of The Language of Medicine. Luke Held, Content
Development Manager, is always responsive, available, and
effective in managing the many details of the project. I appreciate
Linda Woodard, Senior Content Strategist, for her expert
management and steadfast support of my books.
I am grateful to Annie Martin, Director, Book Production, Jeff
Pa erson, Book Production Manager, and Julie Eddy, Publishing
Services Manager, for their superb production efforts. Abbie
Bradberry, Book Production Specialist, tirelessly and effectively
handled the day-to-day aspects of the production process. Thank
you, Abbie! Kim Denando and Amy Buxton, created and directed
the design for this edition. I appreciate their expertise and
responsiveness.
I continue to be impressed by the talents of the entire marketing
team, especially Julie Burche , Senior Director of Product
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Portfolio Marketing and Samantha Page, Marketing Manager,
Product Portfolio Marketing. They do a phenomenal job keeping
The Language of Medicine in-step with the needs of instructors and
students.
Thanks to Manju Thirumalaivasan, Senior Multimedia Producer
and Prakash Kannan, Multimedia Team Lead, for their work on
the electronic products associated with this new edition.
A very special note of gratitude to the extraordinary and
devoted sales team at Elsevier Health Sciences, which is beyond
compare! Led by Bryan Gripka, Vice President of Sales, this
dedicated team works tirelessly to bring my books and learning
system to the marketplace. You are the best!!!
My family and friends continue to be my greatest comfort and
support. The kids, Noonie, Brandon, and Marla, are always “in
my corner.” The grandkids, Bebe, Solomon, Ben, Gus, Louisa, and
Amari make me feel “on top of the world.” Juliana DoCarmo, by
managing so many day-to-day responsibilities, allows me the
luxury of being able to work and concentrate. I am grateful for
Bob Williams, photographic specialist, who continues to provide
expert advice on images throughout the book. My husband,
Bruce, has always encouraged my passion for teaching and
writing, and given me the space and time to enjoy both. I rely on
his calm reassurance and his willingness to answer all questions
medical or otherwise. Lastly, our canine kids, Ginger and Fred,
remain the love of our lives, providing countless hours of
excitement and enjoyment.
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Reviewers
The following persons reviewed the text and/or the ancillaries:
MEDICAL REVIEWERS
Elizabeth Chabner Thompson MD, MPH
CEO/Founder of Masthead
Scarsdale, New York
Bruce A. Chabner MD
Clinical Director, Emeritus
Allen Distinguished Investigator
Massachuse s General Hospital Cancer Center
Professor of Medicine
Harvard Medical School
Boston, Massachuse s
Lisa Caulley MD, MPH
Otolaryngology/Head & Neck Surgery
The O awa Hospital
O awa, Canada
Michael J. Curtin MD
Medical Director, St. Luke’s Sports Medicine
Orthopedic Surgery and Sports Medicine
St. Luke's Clinic
Boise, Idaho
Morris A. Fisher MD
A ending Neurologist
Edward Hines Jr. Veterans Hospital
Hines, Illinois
Professor of Neurology Loyola University
Chicago Stritch School of Medicine
Maywood, Illinois
Carlos A. Jamis-Dow M.D.
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Radiologist
Su er Medical Group
Sacramento, California
Jay Loeffler MD
Chief of Radiation Oncology
Massachuse s General Hospital Cancer Center
Herman and Joan Suit Professor
Harvard Medical School
Boston, Massachuse s
Dan L. Longo MD
Deputy Editor
New England Journal of Medicine
Professor of Medicine
Harvard Medical School
Boston, Massachuse s
Neera R. Nathan MD, MSHS
Massachuse s General Hospital
Boston, Massachuse s
Tomas G. Neilan MD, MPH
Division of Cardiology
Department of Medicine
Massachuse s General Hospital
Boston, Massachuse s
Aparna Parikh MD
Massachuse s General Hospital
Boston, Massachuse s
Mihir Parikh MD
Beth Israel Deaconess Medical Center
Boston, Massachuse s
Cliff Rosen MD
Rosen Laboratory
Scarborough, Maine
James L. Rosenzweig MD
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Endocrinology, Diabetes and Metabolism
Hebrew Rehabilitation Center
Roslindale, MA
Henry E. Schniewind MD,
Boston, Massachuse s
Sydney Schoensee PT, DPT, FAAOMPT
St. Luke’s Rehabilitation
McCall, Idaho
Noëlle S. Sherber MD, FAAD
Dermatologist
Co-Founder, Sherber+Rad
Washington, DC
Leigh H. Simmons MD
Assistant Professor of Medicine
Harvard Medical School
Division of General Internal Medicine
Massachuse s General Hospital
Boston, Massachuse s
Daniel I. Simon MD
President, University Hospitals Case Medical Center
President, Harrington Heart & Vascular Institute
Chief, Division of Cardiovascular Medicine
University Hospitals Health System
Herman K. Hellerstein Chair of Cardiovascular Research and
Professor of Medicine
Case Western Reserve University School of Medicine
Cleveland, Ohio
Jill Smith MD
Chief of Ophthalmology
Newton-Wellesley Hospital
Newton, Massachuse s
Daniel Talmasov MD
Harvard Longwood Psychiatry
Boston, Massachuse s
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Beatrix Thompson,
New Haven, Connecticut
Cornelia L. Trimble MD
Professor
Departments of Gynecology and Obstetrics, Oncology, and
Pathology
The Johns Hopkins Medical Institutions
Baltimore, Maryland
INSTRUCTOR REVIEWERS
Teresa S. Boyer MSN, APN-BC, PMHNP
Associate Professor of Nursing
Motlow College
Lynchburg, Tennessee
Cheryl Christopher RHIA
Adjunct
Borough of Manha an Community College
New York, New York
Mary Jane Durksen Medical Office Administrator Diploma
Lead Virtual Instructor/Courseware Developer
AOLC
Ontario, Canada
Shelba Durston MSN, RN, CCRN, SAFE
Professor of Nursing
San Joaquin Delta College
Stockton, California
Erin J. Fi gerald RN, BSN, MBA
Norwalk Community College
Norwalk, Connecticut
Rosalie Griffith RN, MSN, MA.Ed
Nursing Success Coordinator
Chesapeake College
Wye Mills, Maryland
Shawn McGowan
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Manager, Healthcare Division
AOLC
Ontario, Canada
Angela J. Moore RN, MSN Ed.
Assistant Director of Nurses
Career Care Institute
Lancaster, California
José L. Mosqueda
Healthcare Lead Instructor
Erie Neighborhood House
Chicago, Illinois
Mary Prorok RN, MSN
Instructor
South Hills School of Business & Technology
Altoona, Pennsylvania
Danielle Robel MBA
Professor, Health Sciences
AAMA, Milwaukee Area Technical College
Milwaukee Wisconsin
Deb Stockberger MSN, RN
Health Division Instructor
North Iowa Area Community College
Mason City, Iowa
Donna J. Wilde MPA, RHIA
Professor, Health Informatics and Information Management
Shoreline Community College
Sea le, Washington
Charles K. Williston BA, MS, CPC
Instructor
Traviss Career Center
Lakeland, Florida
Lynda Wilson Masters in the Art of Teaching, EMT-Paramedic
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Professor of Medical Terminology
Valencia College
Orlando, Florida
Mindy Wray MA, CMA (AAMA), RMA
Program Director, Medical Assisting
ECPI University
Greensboro, North Carolina
Carole Zeglin MSEd, BSMT, RMA
Associate Professor/Director Medical Laboratory Technology,
Medical Assisting, and Phlebotomy/Specimen Processing
Programs
Westmoreland County Community College
Youngwood, Pennsylvania
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CHAPTER 1
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Basic Word Structure
CHAPTER SECTIONS:
Objectives in Studying the Medical Language 2
Word Analysis 3
Terminology 6
Practical Applications 16
Exercises 17
Answers to Exercises 24
Pronunciation of Terms 27
Review Sheet 29
CHAPTER GOALS
• Identify basic objectives to guide your study of the medical language.
• Divide medical words into their component parts.
• Learn the meanings of basic combining forms, suffixes, and prefixes of the medical
language.
• Use these combining forms, suffixes, and prefixes to build medical words.
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Objectives in Studying the Medical Language
There are three objectives to keep in mind as you study medical terminology:
• Analyze words by dividing them into component parts.
Your goal is to learn the tools of word analysis that will
make understanding complex terminology easier. Do
not simply memorize terms; think about dividing
terms into their component parts—the building
blocks of terminology. This book shows how to
separate both complicated and simple terms into
understandable word elements. Medical terms are
much like jigsaw puzzles in that they are constructed
of small pieces that make each word unique, with
one major difference: The pieces can be shuffled up
and used in lots of combinations to make other
words as well. As you become familiar with word
parts and learn what each means, you will be able to
recognize those word parts in totally new
combinations in other terms.
• Relate the medical terms to the structure and function of
the human body.
Memorization of terms, although essential to retention
of the language, should not become the primary
objective of your study. A major focus of this book is
to explain terms in the context of how the body works
in health and disease. Medical terms explained in
their proper context also will be easier to remember.
Thus, the term hepatitis, meaning inflammation (itis) of the liver (hepat), is be er understood when
you know where the liver is and how it functions. No
previous knowledge of biology, anatomy, or
physiology is needed for this study. Explanations in
this book are straightforward and basic.
• Be aware of spelling and pronunciation problems.
Some medical terms are pronounced alike but are
spelled differently, which accounts for their different
meanings. For example, ilium and ileum have
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identical pronunciations, but the first term, ilium,
means a part of the hip bone, whereas the second
term, ileum, refers to a part of the small intestine
(Figure 1-1). Even when terms are spelled correctly,
they can be misunderstood because of incorrect
pronunciation. For example, the urethra (u-RE-thrah)
is the tube leading from the urinary bladder to the
outside of the body, whereas a ureter (U-reh-ter) is
one of two tubes, each leading from a single kidney
and inserting into the urinary bladder. Figure 1-2
illustrates the different anatomy of the urethra and
the ureters.
FIGURE 1-1 The terms ileum and ilium can be confusing
because they are pronounced alike and refer to body parts
located in the same general region of the body. HINT: The
ileum, with an “e,” is part of the digestive tract, which has to
do with eating.
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FIGURE 1-2 Male urinary tract. The terms urethra and
ureter can be confusing because they are both tubes of the
urinary system, but spellings and pronunciations are different.
Notice their locations: two ureters between the kidneys and
urinary bladder and one urethra between the urinary bladder
and the outside of the body. HINT: Ureter has two “e's” and
urethra has just one “e.”
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Word Analysis
Studying medical terminology is very similar to learning a new language. At first,
the words seem strange and complicated, although they may stand for commonly
known disorders and terms. For example, cephalgia means “headache,” and an
ophthalmologist is an “eye doctor.”
Your first job in learning the language of medicine is to understand how to divide
words into their component parts. Logically, most terms, whether complex or
simple, can be broken down into basic parts and then understood. For example,
consider the following term, which is divided into three parts:
The root is the foundation of the word. All medical terms have one or more roots.
For example, the root hemat means blood.
The suffix is the word ending. All medical terms have a suffix. The suffix -logy
means process of study.
The combining vowel—usually o, as in this term—links the root to the suffix or the
root to another root. A combining vowel has no meaning of its own; it joins one word
part to another.
It is useful to read the meaning of medical terms starting from the suffix and then
going back to the beginning of the term. Thus, the term hematology means process of
study of blood.
Here is another familiar medical term:
Electrocardiogram, reading from the suffix back to the beginning of the term,
means record of the electricity in the heart.
Notice that there are two combining vowels—both o—in this term. The first o
links the two roots electr and cardi; the second o links the root cardi and the suffix gram.
Try another term:
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Gastritis, reading from the end of the term (suffix) to the beginning, means
inflammation of the stomach.
Notice that the combining vowel, o, is missing in this term. This is because the
suffix, -itis, begins with a vowel. The combining vowel is dropped before a suffix
that begins with a vowel. It is retained, however, between two roots, even if the
second root begins with a vowel.
Consider the following term:
The entire term means process of study of the stomach and intestines.
Notice that the combining vowel is retained between gastr and enter, even
though the second root, enter, begins with a vowel. When a term contains two or
more roots related to parts of the body, anatomic position often determines which
root goes before the other. For example, the stomach receives food first, before the
small intestine—so the word is formed as gastroenterology, not “enterogastrology.”
In summary, remember three general rules:
1. READ the meaning of medical terms from the suffix back to the beginning of
the term and across.
2. DROP the combining vowel (usually o) before a suffix beginning with a
vowel: gastritis, not “gastroitis.”
3. KEEP the combining vowel between two roots: gastroenterology, not
“gastrenterology.”
In addition to the root, suffix, and combining vowel, two other word parts are
commonly found in medical terms. These are the combining form and the prefix.
The combining form is simply the root plus the combining vowel. For example, you
already are familiar with the following combining forms and their meanings:
56
Combining forms are used with many different suffixes. Remembering the
meaning of a combining form will help you understand unfamiliar medical terms.
The prefix is a small part a ached to the beginning of a term. Not all medical
terms contain prefixes, but the prefix can have an important influence on the
meaning. Consider the following examples:
In summary, the important elements of medical terms are the following:
1. ROOT: foundation of the term
2. SUFFIX: word ending
3. PREFIX: word beginning
4. COMBINING VOWEL: vowel (usually o) that links the root to the suffix or
the root to another root
5. COMBINING FORM: combination of the root and the combining vowel
Terminology
In previous examples you have been introduced to the combining forms gastr/o
(stomach), hemat/o (blood), and cardi/o (heart). This section of the chapter presents
a list of additional combining forms, suffixes, and prefixes, with examples of
57
medical words using those word parts. Similar lists are included for each chapter in
the book. Write the meaning of the medical term in the space provided. Then check
the correct pronunciation for each term with the Pronunciation of Terms list on
pages 27 and 28. The Mini-Dictionary, beginning on page 897, includes definitions
for all terms in this book. The Evolve website for The Language of Medicine also
contains audio pronunciations for each term. Use it!
Most medical terms are derived from Greek and Latin roots. Greek, Roman, and
Arabic physicians had developed medically useful concepts and associated
vocabularies long before the 21st century. Greek and Latin origins for medical
terms are presented for your interest on the Evolve website.
Chapter Study Guide
1. Use slashes to divide each term into component parts (aden/oma), and write
its meaning (tumor of a gland) in the space provided. Although most medical
terms are divided easily into component parts and understood, others defy
simple explanation. Information in italics under a medical term helps you
define and understand the term. You can check meanings using the MiniDictionary at the end of this book.
2. Complete the Exercises, pages 17 to 23, and check your answers on pages 24
to 26.
3. Practice your pronunciation of each term using the Pronunciation of Terms
list, pages 27 and 28. Definitions of each term are in the Mini-Dictionary
beginning on page 897.
4. Complete the Review Sheet, pages 29 and 30. Check your answers with the
Glossary of Word Parts page 967. Then, test yourself by writing Review
Sheet terms and meanings on a separate sheet of paper.
5. Make your own flash cards. Using the Review Sheet as a guide, create flash
cards that can be transported wherever you study!
6. Create your own book tabs to have easy access to key concepts and
frequently used sections—for example, the Glossary of Word Parts,
beginning on page 967.
7. Review terms using the audio pronunciations found on the Evolve website.
Notice that you are actively engaging in the learning process by writing terms
and their meanings and testing yourself repeatedly. Here is your study mantra:
READ, WRITE, RECITE, and REVIEW. I guarantee success if you follow these
simple steps. This is a proven method—it really works!
Combining Forms
Write the meaning of each medical term in the space provided.
Remember: You will find every term phonetically pronounced starting on page
27, and you can hear the pronunciations on the Evolve website.
58
COMBINING
MEANING
FORM
aden/o
gland
arthr/o
bi/o
carcin/o
cardi/o
cephal/o
cerebr/o
cis/o
crin/o
cyst/o
cyt/o
derm/o
dermat/o
electr/o
encephal/o
enter/o
erythr/o
gastr/o
glyc/o
TERMINOLOGY
MEANING
adenoma tumor of a gland________________________________________
The suffix -oma means tumor or mass.
adenitis ________________________________________
The suffix -itis means inflammation.
joint
arthritis ________________________________________
life
biology ________________________________________
The suffix -logy is composed of the root log (study) and the final suffix -y
(process or condition).
biopsy ________________________________________
The suffix -opsy means process of viewing. Living tissue is removed from the
body and viewed under a microscope.
cancerous,
carcinoma ________________________________________
cancer
A carcinoma is a cancerous tumor. Carcinomas grow from the epithelial
(surface or skin) cells that cover the outside of the body and line organs,
cavities, and tubes within the body (Figure 1-3A and B).
heart
cardiology ________________________________________
head
cephalic ________________________________________
(seh-FAL-ik) The suffix -ic means pertaining to. A cephalic presentation
describes a “head first” position for the delivery of an infant.
cerebrum
cerebral ________________________________________
(largest part
The suffix -al means pertaining to. Figure 1-4 shows the cerebrum and its
of the brain)
many functional areas.
to cut
incision ________________________________________
The prefix in- means into, and the suffix -ion means process.
excision ________________________________________
The prefix ex- means out.
to secrete (to
endocrine glands ________________________________________
form and
The prefix endo- means within; endocrine glands (e.g., thyroid, pituitary, and
give off)
adrenal glands) secrete hormones directly within (into) the bloodstream. Other
glands, called exocrine glands, release their secretions (e.g., saliva, sweat,
tears, milk) through tubes (ducts) to the outside of the body.
urinary
cystoscopy ________________________________________
bladder; a sac
(sis-TOS-ko-pe) The suffix -scopy is a complex suffix that includes the root
or a cyst (sac
scop, meaning visual examination, and the final suffix -y, meaning process.
containing
fluid)
cell
cytology _______________________________________
See Figure 1-5 for examples of blood cells.
skin
dermatitis _______________________________________
hypodermic _______________________________________
The prefix hypo- means under or below.
electricity
electrocardiogram _______________________________________
The suffix -gram means record. Abbreviated ECG (or sometimes EKG).
brain
electroencephalogram _______________________________________
Abbreviated EEG.
intestines
enteritis _______________________________________
(usually the
The small intestine is narrower but much longer than the large intestine
small
(colon). See Figure 1-1 on page 2, which shows the small and large intestines.
intestine)
red
erythrocyte _______________________________________
The suffix -cyte means cell. Erythrocytes carry oxygen in the blood.
stomach
gastrectomy _______________________________________
The suffix -ectomy means excision or removal. All or, more commonly, part of
the stomach is removed.
gastrotomy _______________________________________
The suffix -tomy is another complex suffix, which contains the root tom,
meaning to cut, and the final suffix -y, meaning process of.
sugar
hyperglycemia _______________________________________
The prefix hyper- means excessive, above, or more than normal. The suffix emia means blood condition.
59
COMBINING
MEANING
FORM
gnos/o
knowledge
gynec/o
hemat/o
hem/o
woman,
female
blood
hepat/o
iatr/o
liver
treatment,
physician
leuk/o
white
log/o
nephr/o
study of
kidney
neur/o
onc/o
nerve
tumor
(cancerous)
ophthalm/o
eye
oste/o
bone
path/o
disease
ped/o
child
psych/o
mind
radi/o
x-rays
ren/o
kidney
rhin/o
nose
TERMINOLOGY
MEANING
diagnosis ______________________________________
The prefix dia- means complete. The suffix -sis means state or condition of. A
diagnosis is made after sufficient information has been obtained about the
patient's condition. Literally, it is a “state of complete knowledge.”
prognosis ______________________________________
The prefix pro- means before. Literally “knowledge before,” a prognosis is a
prediction about the outcome of an illness, but it is always given after the
diagnosis has been determined.
gynecology ______________________________________
hematology ______________________________________
hematoma ______________________________________
In this term, -oma means a mass or collection of blood, rather than a growth of
cells (tumor). A hematoma forms when blood escapes from blood vessels and
collects as a clot in a cavity or organ or under the skin. See Figure 1-6.
hemoglobin ______________________________________
The suffix -globin means protein. Hemoglobin carries oxygen in red blood cells.
hepatitis ______________________________________
iatrogenic ______________________________________
The suffix -genic means pertaining to producing, produced by, or produced in.
Iatrogenic conditions are adverse effects that result from treatment or
intervention by a physician.
leukocyte ______________________________________
This blood cell helps the body fight disease.
dermatology ______________________________________
nephritis ______________________________________
nephrology ______________________________________
neurology ______________________________________
oncology _______________________________________
oncologist ______________________________________
The suffix -ist means one who specializes in a field of medicine (or other
profession).
ophthalmoscope ______________________________________
(of-THAL-mo-skope) The suffix -scope means an instrument for visual
examination. HINT: Pronunciation helps! The first syllable is “off” and
here the “f” sound is spelled “ph.”
osteitis ______________________________________
osteoarthritis ______________________________________
This condition of aging is actually a degeneration of bones and joints often
accompanied by inflammation.
pathology ______________________________________
pathologist ______________________________________
A pathologist examines biopsy samples microscopically and examines dead
bodies to determine the cause of death.
pediatric ______________________________________
Notice that ped/o is also in the term orthopedist. Orthopedists once were
doctors who straightened (orth/o means straight) children's bones and
corrected deformities. Nowadays, orthopedists specialize in disorders of bones
and muscles in people of all ages.
psychology ______________________________________
psychiatrist ______________________________________
radiology ______________________________________
Low-energy x-rays are used for diagnostic imaging.
renal ______________________________________
Ren/o (Latin) and nephr/o (Greek) both mean kidney. Ren/o is used with -al
(Latin) to describe the kidney, whereas nephr/o is used with other suffixes such
as -osis, -itis, and -ectomy (Greek) to describe abnormal conditions and
operative procedures.
rhinitis ______________________________________
60
COMBINING
MEANING
FORM
sarc/o
flesh
sect/o
thromb/o
ur/o
TERMINOLOGY
MEANING
sarcoma ______________________________________
This is a cancerous (malignant) tumor. A sarcoma (Figure 1-7) grows from
cells of “fleshy” connective tissue such as muscle, bone, and fat, whereas a
carcinoma (another type of cancerous tumor) grows from epithelial cells that
line the outside of the body or the inside of organs in the body.
to cut
resection ______________________________________
The prefix re- means back. A resection is a cu ing back in the sense of cu ing
out or removal (excision). A gastric resection is a gastrectomy, or excision of
the stomach.
clot, clo ing
thrombocyte ______________________________________
Also known as platelets, these cells help clot blood. A thrombus is the actual
clot that forms, and thrombosis (-osis means condition) is the condition of
clot formation.
urinary tract, urologist ______________________________________
urine
FIGURE 1-3 A. Carcinoma of the skin. This is a basal cell carcinoma, the
most common form of skin cancer. It usually occurs on sun-damaged skin. B.
Esophageal carcinoma is a cancerous tumor of the esophagus (tube leading
from the throat to the stomach).
61
FIGURE 1-4 Cerebrum and the functions it controls. A cerebrovascular
accident (CVA), or stroke, occurs when blood vessels (vascul/o means blood
vessel) are damaged in the cerebrum and blood is prevented from reaching
functional areas of the brain. Cells, deprived of oxygen and nutrients, are
damaged, causing loss of movement or speech and other signs and symptoms
of a CVA.
FIGURE 1-5 Blood cells. Notice red blood cells (erythrocytes), a white blood
cell (leukocyte), and clotting cells (thrombocytes or platelets).
62
FIGURE 1-6 A, Notice the hematoma under the nail. B, Hematoma from
broken ribs.
FIGURE 1-7 Sarcoma of muscle in the thigh. (Courtesy Dr. Sam Yoon, Sloan
Kettering Hospital, New York City.)
Suffixes
63
SUFFIX
-ac
-al
-algia
MEANING
pertaining to
pertaining to
pain
-cyte
cell
-ectomy excision, removal
-emia
blood condition
-genic
pertaining to
producing, produced
by, or produced in
-globin protein
-gram
record
-ic, -ical pertaining to
-ion
-ist
-itis
-logy
-oma
process
specialist
inflammation
process of study
tumor, mass, swelling
-opsy
process of viewing
-osis
condition, usually
abnormal (slight
increase in numbers
when used with blood
cells)
-pathy
disease condition
-scope
instrument to visually
examine
-scopy
process of visually
examining
-sis
-tomy
state of; condition
process of cu ing,
incision
process, condition
-y
TERMINOLOGY
MEANING
cardiac ________________________________________
neural _________________________________________
arthralgia ________________________________________
neuralgia ________________________________________
erythrocyte ________________________________________
nephrectomy ________________________________________
leukemia ________________________________________
Literally, this term means “a blood condition of white (blood cells).”
Actually, it is a condition of blood in which cancerous white blood cells
proliferate (increase in number).
carcinogenic ________________________________________
Cigare e smoke is carcinogenic.
pathogenic ________________________________________
Many viruses and bacteria are pathogenic organisms.
osteogenic sarcoma ________________________________________
This is a malignant tumor produced in bone.
hemoglobin ________________________________________
electroencephalogram ________________________________________
gastric ________________________________________
neurologic ________________________________________
Log/o means study of.
excision ________________________________________
ophthalmologist ________________________________________
cystitis ________________________________________
endocrinology ________________________________________
hepatoma ________________________________________
A hepatoma (hepatocellular carcinoma) is a malignant tumor of the
liver.
biopsy ________________________________________
Biopsy specimens are obtained and viewed under a microscope.
nephrosis ________________________________________
leukocytosis ________________________________________
This condition, a slight increase in normal white blood cells, occurs as
white blood cells multiply to fight an infection. Don't confuse
leukocytosis with leukemia, which is a cancerous (malignant) condition
marked by high levels of abnormal, immature white blood cells.
encephalopathy ________________________________________
(en-sef-ah-LOP-ah-the)
adenopathy ________________________________________
(ah-deh-NOP-ah-the) Also known as lymphadenopathy, this condition
refers to lymph nodes (collection of stationary cells along the path of lymph
vessels) that are are enlarged due to infection or during the spread of
malignant (cancerous) tumors.
endoscope ________________________________________
Endo- means within. A cystoscope is a type of endoscope.
A periscope is a nonmedical term meaning an instrument to visually
examine an area around (peri-) an obstacle.
endoscopy ________________________________________
(en-DOS-ko-pe)
Endoscopy is performed with an endoscope. A common endoscopic
procedure is a colonoscopy (colon/o = colon or large intestine).
prognosis ________________________________________
osteotomy ________________________________________
(os-te-OT-o-me)
gastroenterology ________________________________________
Prefixes
64
PREFIX MEANING
a-, an- no, not,
without
aut-,
autodiaendoepiex-,
exohyperhypo-
inperiproreretrosubtrans-
TERMINOLOGY
MEANING
anemia ________________________________________
Anemia is a decreased number of erythrocytes or an abnormality of the hemoglobin (a
chemical) within the red blood cells. This results in decreased delivery of oxygen to
cells of the body. Anemic patients look so pale that early physicians thought they were
literally “without blood.”
self, own
autopsy ________________________________________
This term literally means “process of viewing by oneself.” Hence, an autopsy is the
examination of a dead body with one's own eyes to determine the cause of death and
nature of disease.
complete,
diagnosis ________________________________________
through
The plural of diagnosis is diagnoses.
within
endocrinologist __________________________________
above, upon epigastric __________________________________
epidermis __________________________________
This outermost layer of skin lies above the middle layer of skin, known as the dermis.
out, outside
excision __________________________________
of, outward
exocrine glands __________________________________
excessive,
hyperthyroidism __________________________________
above, more
The suffix -ism means process or condition.
than normal
deficient,
hypogastric _____________________________________
below,
When hypo- is used with a part of the body, it means below.
under, less
hypoglycemia _____________________________________
than normal
In this term, hypo- means deficient.
into, in
incision _____________________________________
surrounding,
pericardium _____________________________________
around
The suffix -um means a structure. The pericardium is the membrane that surrounds
the heart.
before,
prostate gland _____________________________________
forward
This exocrine gland “stands” (-state) before or in front of the male urinary bladder (see
Figure 1-2). It produces semen, which contains fluid and sperm cells.
back,
resection _____________________________________
backward,
This is an operation in which tissue is “cut back” or removed. The Latin resectio
again
means a trimming or pruning.
behind
retrocardiac _____________________________________
below, under subhepatic _____________________________________
across,
transhepatic _____________________________________
through
Complex Suffixes
Many suffixes, like -scopy, contain an embedded root word. Other examples are opsy (ops is a root) and -logy (log is a root).
Hyperglycemia and Diabetes
Hyperglycemia (high blood sugar) most frequently is associated with diabetes.
People with diabetes have high blood sugar levels because they lack insulin (in
type 1 diabetes) or have ineffective insulin (in type 2 diabetes). Insulin is the
hormone normally released by the pancreas (an endocrine gland near the stomach)
to “escort” sugar from the bloodstream into cells. Sugar (glucose) is then broken
down in cells to release energy. When insulin is not present, sugar cannot enter
cells and builds up in the bloodstream (hyperglycemia).
65
Urologist and Nephrologist
A urologist is a surgeon who operates on the urinary tract and the organs of the
male reproductive system. A nephrologist is an internal medicine specialist
(nonsurgical) who diagnoses and treats disorders of kidneys. Both urologists and
nephrologists are medical doctors.
Ophthalmologist, Optometrist, Optician
An ophthalmologist is a physician who specializes in diagnosing and treating
(surgically and medically) disorders of the eye. An optometrist is a health care
professional who examines (metr/o = to measure) eyes and prescribes corrective
lenses and may treat eye diseases. An optician grinds lenses and fits glasses but
does not examine eyes, prescribe corrective lenses, or treat eye diseases.
What is Chronic Traumatic Encephalopathy?
Chronic (pertaining to over a long period of time) traumatic encephalopathy
(CTE) is a serious brain injury associated with high-impact head trauma (as may be
found in football and boxing). The autopsy images below show a normal brain and
a brain affected by CTE.
Plurals
Terms ending in -is (diagnosis, prognosis) form their plural by dropping the -is and
adding -es. See Appendix I, page 989, for other rules on formation of plurals.
Understanding Hyperthyroidism
In hyperthyroidism, a hyperactive thyroid gland (an endocrine gland in the neck)
secretes a greater than normal amount of thyroxine (thyroid hormone, or T4).
Because thyroxine causes cells to burn fuel and release energy, signs and symptoms
of hyperthyroidism are increased energy level and nervousness, tachycardia
(increased heart rate), weight loss, and exophthalmos (bulging eyeballs).
66
Practical Applications
This section provides an opportunity for you to use your skill in understanding
medical terms in this chapter and to increase your knowledge of new terms. Be
sure to check your answers with the Answers to Practical Applications on page 27.
You should find helpful explanations there.
Specialists
Match the abnormal condition in Column I with the physician (specialist) who
treats it in Column II. Write the le er of the correct specialist in the space provided.
COLUMN I: Abnormal Conditions
1. heart a ack
2. ovarian cysts
3. bipolar (manic-depressive) disorder
4. breast adenocarcinoma
5. iron deficiency anemia
6. retinopathy
7. cerebrovascular accident (stroke)
8. renal failure
9. inflammatory bowel disease
10. prostatic adenocarcinoma
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
67
COLUMN II: Physicians (Specialists)
A. gastroenterologist
B. hematologist
C. nephrologist
D. cardiologist
E. oncologist
F. gynecologist
G. urologist
H. ophthalmologist
I. neurologist
J. psychiatrist
Exercises
The exercises that follow are designed to help you learn the terms presented in the
chapter. Writing terms over and over again is a good way to study this new
language. You will find the answers to these exercises starting on page 24. This
makes it easy to check your work. As you check each answer, you not only will
reinforce your understanding of a term but often will gain additional information
from the answer.
Each exercise is designed not as a test, but rather as an opportunity for you to
learn the material.
A Complete the following sentences.
1. Word beginnings are called
_________________________________.
2. Word endings are called
___________________________________.
3. The foundation of a word is known as the
_____________________.
4. A le er linking a suffix and a root, or linking two roots, in a
term is the _______________________.
5. The combination of a root and a combining vowel is known
as the ___________________________.
B Give the meanings of the following combining forms.
1. cardi/o
___________________________________________________
2. aden/o
___________________________________________________
3. bi/o
_____________________________________________________
4. cerebr/o
_________________________________________________
5. cephal/o
_________________________________________________
6. arthr/o
__________________________________________________
7. carcin/o
_________________________________________________
68
8. cyst/o
__________________________________________________
9. cyt/o
___________________________________________________
10. derm/o or dermat/o
_______________________________________
11. encephal/o
______________________________________________
12. electr/o
_________________________________________________
C Give the meanings of the following suffixes.
1. -oma
____________________________________________________
2. -al
_____________________________________________________
_
3. -itis
_____________________________________________________
4. -logy
____________________________________________________
5. -scopy
___________________________________________________
6. -ic
_____________________________________________________
_
7. -gram
____________________________________________________
8. -opsy
____________________________________________________
D Using slashes, divide the following terms into parts, and
give the meaning of the entire term.
1. cerebral
___________________________________________________
2. biopsy
___________________________________________________
69
3. adenitis
__________________________________________________
4. cephalic
__________________________________________________
5. carcinoma
_________________________________________________
6. cystoscopy
________________________________________________
7. electrocardiogram
___________________________________________
8. cardiology
_________________________________________________
9. electroencephalogram
________________________________________
10. dermatitis
_________________________________________________
11. arthroscopy
________________________________________________
12. cytology
__________________________________________________
E Give the meanings of the following combining forms.
1. erythr/o
__________________________________________________
2. enter/o
___________________________________________________
3. gastr/o
___________________________________________________
4. gnos/o
___________________________________________________
5. hemat/o
__________________________________________________
6. cis/o
_____________________________________________________
7. nephr/o
___________________________________________________
70
8. leuk/o
____________________________________________________
9. iatr/o
____________________________________________________
10. hepat/o
__________________________________________________
11. neur/o
___________________________________________________
12. gynec/o
__________________________________________________
F Complete the medical term, based on its meaning as
provided.
1. white blood cell: _________________________cyte
2. inflammation of the stomach:
gastr_________________________
3. pertaining to being produced by treatment:
_________________________genic
4. study of kidneys: _________________________logy
5. red blood cell: _________________________cyte
6. mass of blood: _________________________oma
7. process of viewing living tissue (using a microscope):
bi_________________________
8. pain of nerves: neur_________________________
9. process of visual examination of the eye:
_________________________scopy
10. inflammation of the small intestine:
_________________________itis
G Select from the combining forms below to match the
numbered English terms. Write the correct combining form
in the space provided.
onc/o
ophthalm/o
oste/o
path/o
71
psych/o
radi/o
ren/o
rhin/o
sarc/o
sect/o
thromb/o
ur/o
English Terms
1. kidney ________________________________
2. disease ________________________________
3. eye ___________________________________
4. to cut _________________________________
5. nose __________________________________
6. flesh __________________________________
7. mind __________________________________
8. urinary tract ____________________________
9. bone ___________________________________
10. x-rays ________________________________
11. clo ing _______________________________
12. tumor ________________________________
H Underline the suffix in each term, and then give the meaning
of the term.
1. ophthalmoscopy
_____________________________________________________
__________
2. ophthalmoscope
_____________________________________________________
__________
3. oncology
_____________________________________________________
________________
72
4. osteitis
_____________________________________________________
__________________
5. psychosis
_____________________________________________________
________________
6. thrombocyte
_____________________________________________________
_____________
7. renal
_____________________________________________________
___________________
8. nephrectomy
_____________________________________________________
_____________
9. osteotomy
_____________________________________________________
_______________
10. resection
_____________________________________________________
_______________
11. carcinogenic
_____________________________________________________
____________
12. sarcoma
_____________________________________________________
________________
I Match the suffix in Column I with its meaning in Column II.
Write the correct meaning in the space provided.
73
COLUMN I
Suffix
1. -algia _______________________________
2. -ion ________________________________
3. -emia _______________________________
4. -gram _______________________________
5. -scope _______________________________
6. -osis ________________________________
7. -ectomy _____________________________
8. -genic _______________________________
9. -pathy _______________________________
10. -tomy ______________________________
11. -itis ________________________________
12. -cyte _______________________________
13. -globin ______________________________
COLUMN II
Meaning
condition, usually abnormal
blood condition
cell
disease condition
process of cu ing, incision
inflammation
instrument to visually examine
pain
pertaining to producing, produced by, or produced in
process
protein
record
excision, removal (resection)
J Select from the listed terms to complete the sentences that
follow.
arthralgia
carcinogenic
cystitis
encephalopathy
endocrine
exocrine
hematoma
hepatoma (hepatocellular carcinoma)
iatrogenic
leukemia
leukocytosis
neuralgia
1. When Paul smoked cigare es, he inhaled a
______________________ substance with each puff.
2. Sally's sore throat, fever, and chills made her doctor order a
white blood cell count. The results, indicating infection,
showed a slight increase in normal cells, a condition called
______________________.
3. Mr. Smith's liver enlarged, giving him abdominal pain. His
radiologic tests and biopsy revealed a malignant tumor, or
______________________.
4. Mrs. Rose complained of pain in her hip joints, knees, and
shoulders each morning. She was told that she had painful
74
joints, or ______________________.
5. Dr. Black was trained to treat disorders of the pancreas,
thyroid gland, adrenal glands, and pituitary gland. Thus, he
was an expert in the ______________________ glands.
6. Ms. Walsh told her doctor she had pain when urinating.
After tests, the doctor's diagnosis was inflammation of the
urinary bladder, or ______________________.
7. Elizabeth's overhead tennis shot hit David in the thigh,
producing a large _________________. His skin looked
bruised and the affected area was tender.
8. Mr. Bell's white blood cell count is 10 times higher than
normal. Examination of his blood shows cancerous white
blood cells. His diagnosis is _________________________.
9. Mr. Kay was resuscitated (revived from potential or
apparent death) in the emergency department after
experiencing a heart a ack. Unfortunately, he suffered a
broken rib as a result of the physician's chest compressions.
This is an example of a/an _________________________
fracture.
10. After playing one season for a professional football team,
Bill Smith decided to retire because he worried about the
dangers of concussions and head trauma—a condition
called CTE, or chronic traumatic
_________________________.
K Give the meanings of the following prefixes.
1. dia_____________________________________________________
_
2. pro_____________________________________________________
_
3. aut-, auto_________________________________________________
4. a-, an____________________________________________________
75
5. hyper____________________________________________________
6. hypo_____________________________________________________
7. epi_____________________________________________________
_
8. endo_____________________________________________________
9. retro_____________________________________________________
10. trans____________________________________________________
11. peri_____________________________________________________
12. ex-, exo_________________________________________________
13. sub_____________________________________________________
14. re_____________________________________________________
_
L Underline the prefix in the following terms, and then give the
meaning of the entire term.
1. diagnosis
_____________________________________________________
_____________
2. prognosis
_____________________________________________________
_____________
3. subhepatic
_____________________________________________________
____________
4. pericardium
_____________________________________________________
76
___________
5. hyperglycemia
_____________________________________________________
_________
6. hypodermic
_____________________________________________________
___________
7. epigastric
_____________________________________________________
_____________
8. resection
_____________________________________________________
_____________
9. hypoglycemia
_____________________________________________________
_________
10. anemia
_____________________________________________________
_____________
M Complete the following terms (describing areas of
medicine), based on their meanings as given.
1. study of the urinary tract: ________________________ logy
2. study of women and women's diseases:
________________________ logy
3. study of blood: ________________________ logy
4. study of tumors: ________________________ logy
5. study of the kidneys: ________________________ logy
6. study of nerves: ________________________ logy
7. treatment of children: ________________________ iatrics
8. study of x-rays in diagnostic imaging:
________________________ logy
9. study of the eyes: ________________________ logy
10. study of the stomach and intestines:
________________________ logy
77
11. study of glands that secrete hormones:
________________________ logy
12. treatment of the mind: ________________________ iatry
13. study of disease: ________________________ logy
14. study of the heart: ________________________ logy
N Give the meaning of the underlined word part, and then
define the term.
1. cerebrovascular accident
________________________________________________
2. encephalitis
_____________________________________________________
_____
3. cystoscope
_____________________________________________________
______
4. transhepatic
_____________________________________________________
_____
5. osteogenic sarcoma
_____________________________________________________
_______
6. hypogastric
_____________________________________________________
______
7. endocrine glands
_____________________________________________________
__
8. nephrectomy
_____________________________________________________
_____
9. exocrine glands
_____________________________________________________
___
10. neuralgia
_____________________________________________________
78
_______
O Select from the terms listed below to complete the sentences
that follow.
anemia
biopsy
diagnosis
leukemia
nephrologist
neuropathy
oncogenic
oncologist
osteoarthritis
pathogenic
prognosis
psychiatrist
psychologist
thrombocyte
thrombosis
urologist
1. Pamela Crick is 72 years old and suffers from a degenerative
joint disease that is caused by the wearing away of tissue
around her joints. This disease, which literally means
“inflammation of bones and joints,” is
____________________________.
2. The __________________________ sample was removed
during surgery and sent to a pathologist to be examined
under a microscope for a proper diagnosis.
3. A/An ___________________________ performed surgery to
remove Mr. Simon's cancerous kidney.
4. Ms. Rose has suffered from diabetes with hyperglycemia for
many years. This condition can lead to long-term
complications, such as the disease of nerves called diabetic
______________________.
79
5. A virus or a bacterium produces disease and is therefore
a/an _________________________ organism.
6. Jordan has a disease caused by abnormal hemoglobin in his
erythrocytes. The erythrocytes change shape, collapsing to
form sickle-shaped cells that can become clots and stop the
flow of blood. His condition is called sickle cell
_____________________.
7. Dr. Max Shelby is a physician who treats carcinomas and
sarcomas. He is a/an ______________.
8. Bill had difficulty stopping the bleeding from a cut on his
face while shaving. He knew his medication caused him to
have decreased platelets, or a low
_____________________________ count, and that probably
was the reason his blood was not clo ing very well.
9. Dr. Susan Parker told Paul that his condition would improve
with treatment in a few weeks. She said his
__________________________ is excellent and he can expect
total recovery.
10. After fleeing the World Trade Center on September 11,
2001, Mrs. Jones had many problems with her job, her
husband, and her family relationships. She went to see a
_________________, who prescribed drugs to treat her
depression.
P Circle the correct term to complete each sentence.
1. Ms. Brody had a cough and fever. Her doctor instructed her
to go to the (pathology, radiology, hematology) department
for a chest x-ray examination.
2. After she gave birth to her fourth child, Ms. Thompson had
problems holding her urine (a condition known as urinary
incontinence). She made an appointment with a
(gastroenterologist, pathologist, urologist) to evaluate her
condition.
3. Dr. Monroe told a new mother she had lost much blood
during delivery of her child. She had (anemia, leukocytosis,
adenitis) and needed a blood transfusion immediately.
80
4. Mr. Preston was having chest pain during his morning
walks. He made an appointment to discuss his new
symptom with a (nephrologist, neurologist, cardiologist).
5. After my skiing accident, Dr. Curtin suggested (cystoscopy,
biopsy, arthroscopy) to visually examine my swollen,
painful knee.
81
Answers to Exercises
A
1. prefixes
2. suffixes
3. root
4. combining vowel
5. combining form
B
1. heart
2. gland
3. life
4. cerebrum, largest part of the brain
5. head
6. joint
7. cancer, cancerous
8. urinary bladder
9. cell
10. skin
11. brain
12. electricity
C
1. tumor, mass, swelling
2. pertaining to
3. inflammation
4. process of study
5. process of visual examination
82
6. pertaining to
7. record (image)
8. process of viewing
D
1. cerebr/al—pertaining to the cerebrum, or largest part of the
brain
2. bi/opsy—process of viewing life (removal of living tissue and
viewing it under a microscope)
3. aden/itis—inflammation of a gland
4. cephal/ic—pertaining to the head
5. carcin/oma—tumor that is cancerous (cancerous tumor)
6. cyst/o/scopy—process of visually examining the urinary
bladder
7. electr/o/cardi/o/gram—record of the electricity in the heart
8. cardi/o/logy—process of study of the heart
9. electr/o/encephal/o/gram—record of the electricity in the brain
10. dermat/itis—inflammation of the skin
11. arthr/o/scopy—process of visual examination of a joint
12. cyt/o/logy—process of study of cells
E
1. red
2. intestines (usually small intestine)
3. stomach
4. knowledge
5. blood
6. to cut
7. kidney
83
8. white
9. treatment, physician
10. liver
11. nerve
12. woman, female
F
1. leukocyte
2. gastritis
3. iatrogenic
4. nephrology
5. erythrocyte
6. hematoma
7. biopsy
8. neuralgia
9. ophthalmoscopy
10. enteritis
G
1. ren/o
2. path/o
3. ophthalm/o
4. sect/o
5. rhin/o
6. sarc/o
7. psych/o
8. ur/o
9. oste/o
10. radi/o
84
11. thromb/o
12. onc/o
H
1. ophthalmoscopy—process of visual examination of the eye
2. ophthalmoscope—instrument to visually examine the eye
3. oncology—study of tumors
4. osteitis—inflammation of bone
5. psychosis—abnormal condition of the mind
6. thrombocyte—clo ing cell (platelet)
7. renal—pertaining to the kidney
8. nephrectomy—removal (excision or resection) of the kidney
9. osteotomy—incision of (process of cu ing into) a bone
10. resection—process of cu ing back (in the sense of “cu ing
out” or removal)
11. carcinogenic—pertaining to producing cancer
12. sarcoma–tumor of flesh tissue (cancerous tumor found in
connective tissue such as bone, fat and muscle)
I
1. pain
2. process
3. blood condition
4. record (image)
5. instrument to visually examine
6. condition, usually abnormal
7. excision, removal (resection)
8. pertaining to producing, produced by, or produced in
9. disease condition
85
10. process of cu ing, incision
11. inflammation
12. cell
13. protein
J
1. carcinogenic
2. leukocytosis
3. hepatoma (hepatocellular carcinoma)
4. arthralgia
5. endocrine
6. cystitis
7. hematoma
8. leukemia
9. iatrogenic
10. encephalopathy
K
1. complete, through
2. before
3. self, own
4. no, not, without
5. excessive, above, more than normal
6. deficient, below, less than normal
7. above, upon
8. within
9. behind
10. across, through
11. surrounding
86
12. out
13. below, under
14. back
L
1. diagnosis—complete knowledge; a decision about the nature
of the patient's condition after the appropriate tests are done
2. prognosis—before knowledge; a prediction about the outcome
of treatment, given after the diagnosis
3. subhepatic—pertaining to below the liver. A combining vowel
is not needed between the prefix and the root.
4. pericardium—the membrane surrounding the heart
5. hyperglycemia—condition of excessive sugar in the blood
6. hypodermic—pertaining to under the skin
7. epigastric—pertaining to above the stomach
8. resection—process of cu ing back (in the sense of cu ing out)
9. hypoglycemia—condition of deficient (low) sugar in the blood
10. anemia—condition of low numbers of erythrocytes (red blood
cells) or deficient hemoglobin in these cells. Notice that the
root in this term is em, which is shortened from hem, meaning
blood.
M
1. urology
2. gynecology
3. hematology
4. oncology
5. nephrology
6. neurology
7. pediatrics (combining vowel o has been dropped between ped
and iatr)
87
8. radiology
9. ophthalmology
10. gastroenterology
11. endocrinology
12. psychiatry
13. pathology
14. cardiology
N
1. cerebrum (largest part of the brain). A cerebrovascular
accident, or stroke, is damage to the blood vessels of the
cerebrum, leading to death of brain cells.
2. brain. Encephalitis is inflammation of the brain.
3. urinary bladder. A cystoscope is an instrument used to
visually examine the urinary bladder. The cystoscope is
inserted into the urethra and urinary bladder.
4. across, through. Transhepatic means pertaining to across or
through the liver.
5. flesh. Osteogenic sarcoma is a malignant (cancerous) tumor
originating in bone, which is considered a fleshy (connective)
tissue of the body.
6. under, below, deficient. Hypogastric means pertaining to
below the stomach.
7. within. Endocrine glands secrete hormones within the body.
Examples of these are the pituitary, thyroid, and adrenal
glands.
8. excision or resection. Nephrectomy is the removal of a kidney.
9. outside. Exocrine glands secrete chemicals to the outside of the
body. Examples are the sweat, lacrimal or tear-producing,
prostate, and salivary glands.
10. pain. Neuralgia is nerve pain.
88
O
1. osteoarthritis
2. biopsy
3. urologist (a nephrologist is a medical doctor who treats kidney
disorders but does not operate on patients)
4. neuropathy
5. pathogenic
6. anemia
7. oncologist
8. thrombocyte
9. prognosis
10. psychiatrist (a psychologist can treat mentally ill patients but
is not a medical doctor and cannot prescribe medications)
P
1. radiology
2. urologist
3. anemia
4. cardiologist
5. arthroscopy
Answers to Practical Applications
1. D A cardiologist is an internal medicine specialist who takes
additional (fellowship) training in the diagnosis and treatment
of heart disease.
2. F A gynecologist specializes in surgery and internal medicine
to diagnose and treat disorders of the female reproductive
system. Ovarian cysts are sacs of fluid that form on and in the
ovaries (female organs that produce eggs and hormones).
3. J A psychiatrist is a specialist in diagnosing and treating
mental illness. In bipolar disorder (manic-depressive illness),
89
the mood switches periodically from excessive mania
(excitability) to deep depression (sadness, despair, and
discouragement).
4. E An oncologist is an internal medicine specialist who takes
fellowship training in the diagnosis and medical (drug)
treatment of cancer.
5. B A hematologist is an internal medicine specialist who takes
fellowship training in the diagnosis and treatment of blood
disorders such as anemia and clo ing diseases.
6. H An ophthalmologist trains in both surgery and internal
medicine in order to diagnose and treat disorders of the eye.
The retina is a sensitive layer of light receptor cells in the back
of the eye. Retinopathy can occur as a secondary complication
of chronic diabetes (from hyperglycemia).
7. I A neurologist is an internal medicine specialist who takes
fellowship training in the diagnosis and treatment of disorders
of nervous tissue (brain, spinal cord, and nerves). A CVA
causes damage to areas of the brain, resulting in loss of
function.
8. C A nephrologist is an internal medicine specialist who takes
fellowship training in the diagnosis and medical treatment of
kidney disease. A nephrologist does not perform surgery on
the urinary tract, but treats kidney disease with drugs.
9. A A gastroenterologist is an internal medicine specialist who
takes fellowship training in the diagnosis and treatment of
disorders of the gastrointestinal tract. Examples of
inflammatory bowel disease are ulcerative colitis
(inflammation of the large intestine) and Crohn disease
(inflammation of the last part of the small intestine).
10. G A urologist is a surgeon who operates on organs of the
urinary tract and the male reproductive system (such as the
prostate gland). Urologists also prescribe drugs for some
conditions.
Pronunciation of Terms
90
The terms you have learned in this chapter are presented here with their
pronunciations. The CAPITAL le ers indicate the accented syllable.
The meanings for all the terms are in the Mini-Dictionary beginning on page
897. You can also hear each term pronounced on the Evolve website
(h p://evolve.elsevier.com/Chabner/language/).
91
TERM
adenitis
adenoma
adenopathy
anemia
arthralgia
arthritis
autopsy
biology
biopsy
carcinogenic
carcinoma
cardiac
cardiology
cephalic
cerebral
cystitis
cystoscopy
cytology
dermatitis
dermatology
diagnosis
electrocardiogram
electroencephalogram
encephalopathy
endocrine glands
endocrinologist
endocrinology
endoscope
endoscopy
enteritis
epidermis
epigastric
erythrocyte
excision
exocrine glands
gastrectomy
gastric
gastroenterology
gastrotomy
gynecologist
gynecology
hematology
hematoma
hemoglobin
hepatitis
hepatoma
hyperglycemia
hyperthyroidism
hypodermic
hypogastric
hypoglycemia
iatrogenic
incision
leukemia
leukocyte
leukocytosis
nephrectomy
nephritis
nephrology
nephrosis
PRONUNCIATION
ah-deh-NI-tis
ah-deh-NO-mah
ah-deh-NOP-ah-the
ah-NE-me-ah
ar-THRAL-jah
ar-THRI-tis
AW-top-se
bi-OL-o-je
BI-op-se
kar-sih-no-JEN-ik
kar-sih-NO-mah
KAR-de-ak
kar-de-OL-o-je
seh-FAL-ik
seh-RE-bral
sis-TI-tis
sis-TOS-ko-pe
si-TOL-o-je
der-mah-TI-tis
der-mah-TOL-o-je
di-ag-NO-sis
eh-lek-tro-KAR-de-o-gram
eh-lek-tro-en-SEF-ah-lo-gram
en-sef-ah-LOP-ah-the
EN-do-krin glanz
en-do-krin-OL-o-gist
en-do-krin-OL-o-je
EN-do-skope
en-DOS-ko-pe
en-teh-RI-tis
ep-ih-DER-mis
ep-ih-GAS-trik
eh-RITH-ro-site
ek-SIZH-un
EK-so-krin glanz
gas-TREK-to-me
GAS-trik
gas-tro-en-teh-ROL-o-je
gas-TROT-o-me
gi-neh-KOL-o-jist
gi-neh-KOL-o-je
he-mah-TOL-o-je
he-mah-TO-mah
HE-mo-glo-bin
hep-ah-TI-tis
hep-ah-TO-mah
hi-per-gli-SE-me-ah
hi-per-THI-royd-izm
hi-po-DER-mik
hi-po-GAS-trik
hi-po-gli-SE-me-ah
i-ah-tro-JEN-ik
in-SIZH-un
lu-KE-me-ah
LU-ko-site
lu-ko-si-TO-sis
neh-FREK-to-me
neh-FRI-tis
neh-FROL-o-je
neh-FRO-sis
92
TERM
neural
neuralgia
neurologic
neurology
oncologist
oncology
ophthalmologist
ophthalmoscope
osteitis
osteoarthritis
osteogenic sarcoma
osteotomy
pathogenic
pathologist
pathology
pediatric
pericardium
prognosis
prostate gland
psychiatrist
psychology
radiology
renal
resection
retrocardiac
rhinitis
sarcoma
subhepatic
thrombocyte
transhepatic
urologist
PRONUNCIATION
NU-ral
nu-RAL-jah
nu-ro-LOJ-ik
nu-ROL-o-je
ong-KOL-o-jist
ong-KOL-o-ge
of-thal-MOL-o-jist
of-THAL-mo-scope
os-te-I-tis
os-te-o-ar-THRI-tis
os-te-o-JEN-ic sar-KO-mah
os-te-OT-o-me
path-o-JEN-ik
path-OL-o-jist
path-OL-o-je
pe-de-AH-trik
peh-rih-KAR-de-um
prog-NO-sis
PROS-tayt gland
si-KI-ah-trist
si-KOL-o-je
ra-de-OL-o-je
RE-nal
re-SEK-shun
reh-tro-KAR-de-ac
ri-NI-tis
sar-KO-mah
sub-heh-PAT-ik
THROM-bo-site
tranz-heh-PAT-ik
u-ROL-o-gist
Review Sheet
This Review Sheet and the others that follow each chapter are complete lists of the
word elements contained in the chapter. They are designed to pull together the
terminology and to reinforce your learning by giving you the opportunity to write
the meanings of each word part in the spaces provided and to test yourself. Check
your answers with the information in the chapter or in the Glossary (Medical Word
Parts—English) at the end of the book. It's a good idea to tab the Glossary so that
you can easily locate it.
Combining Forms
93
COMBINING FORM
aden/o
arthr/o
bi/o
carcin/o
cardi/o
cephal/o
cerebr/o
cis/o
crin/o
cyst/o
cyt/o
derm/o, dermat/o
electr/o
encephal/o
enter/o
erythr/o
gastr/o
glyc/o
gnos/o
gynec/o
hem/o, hemat/o
hepat/o
iatr/o
leuk/o
log/o
nephr/o
neur/o
onc/o
ophthalm/o
oste/o
path/o
ped/o
psych/o
radi/o
ren/o
rhin/o
sarc/o
sect/o
thromb/o
ur/o
MEANING
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
Suffixes
94
SUFFIX
-ac
-al
-algia
-cyte
-ectomy
-emia
-genic
-globin
-gram
-ic, -ical
-ion
-ist
-itis
-logy
-oma
-opsy
-osis
-pathy
-scope
-scopy
-sis
-tomy
-y
MEANING
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
Prefixes
PREFIX
a-, anaut-, autodiaendoepiex-, exohyperhypoinperiproreretrosubtrans-
MEANING
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
Suffixes Meaning Pertaining To
There are many suffixes that mean “pertaining to.” In this chapter, you have
learned -ac, -al, -ic, and -ical. For a more comprehensive list, see the Glossary
(English to Medical Word Parts), page 967.
95
CHAPTER 2
96
Terms Pertaining to the Body as a
Whole
CHAPTER SECTIONS:
Structural Organization of the Body 32
Abdominopelvic Regions and Quadrants 46
Divisions of the Back (Spinal Column) 48
Positional and Directional Terms 50
Planes of the Body 52
Terminology 53
Practical Applications 57
Exercises 58
Answers to Exercises 63
Pronunciation of Terms 65
Review Sheet 67
CHAPTER GOALS
• Define terms that apply to the structural organization of the body.
• Identify the body cavities and recognize the organs contained within those
cavities.
• Locate and identify the anatomic and clinical divisions of the abdomen.
• Locate and name the anatomic divisions of the back.
• Become acquainted with terms that describe positions, directions, and
planes of the body.
• Identify the meanings for new word elements and use them to understand
medical terms.
97
98
Structural Organization of the Body
This chapter provides you with an orientation to the body as a whole—
cells, tissues, organs, and systems—along with terminology describing
positions and directions within the body. We begin with the smallest
living unit, the cell, and build to an understanding of complex body
systems. In order to know how organs function in both health and
disease, it is important to appreciate the workings of their individual
cellular units.
Cells
The cell is the fundamental unit of all living things (animal or plant).
Cells are everywhere in the human body—every tissue, every organ is
made up of these individual units.
Similarity in Cells
All cells are similar in that they contain a gelatinous substance
composed of water, protein, sugar, acids, fats, and various minerals.
Several parts of a cell, described next, are pictured in Figure 2-1 as they
might look when photographed with an electron microscope. Label the
structures on Figure 2-1. Throughout the book, numbers or le ers in
brackets indicate that the boldface term preceding it is to be used in
labeling.
99
FIGURE 2-1 Major parts of a cell. Ribosomes (RI-bo-sohmz)
are small granules that help the cell make proteins.
The cell membrane [1] not only surrounds and protects the cell but
also regulates what passes into and out of the cell.
The nucleus [2] controls the operations of the cell. It directs cell
division and determines the structure and function of the cell.
Chromosomes [3] are rod-like structures within the nucleus. All
human body cells—except for the sex cells, the egg and the sperm (short
for spermatozoon)—contain 23 pairs of chromosomes. Each sperm and
each egg cell have only 23 unpaired chromosomes. After an egg and a
sperm cell unite to form the embryo, each cell of the embryo then has 46
chromosomes (23 pairs) (Figure 2-2).
100
FIGURE 2-2 Egg and sperm cells, each containing 23
chromosomes.
Chromosomes contain regions called genes. There are several
thousand genes, in an orderly sequence, on every chromosome. Each
gene contains a chemical called DNA (deoxyribonucleic acid). DNA
regulates the activities of the cell according to its sequence (arrangement
into genes) on each chromosome. The DNA sequence resembles a series
of recipes in code. This code, when passed out of the nucleus to the rest
of the cell, directs the activities of the cell, such as cell division and
synthesis of proteins.
A karyotype is a photograph of an individual's chromosomes,
arranged by size, shape, and number (Figure 2-3). Karyotyping can
determine whether chromosomes are normal. For example, an
obstetrician may recommend amniocentesis (puncture of the sac around
the fetus for removal of fluid and cells) for a pregnant woman so that
the karyotype of the baby can be examined.
101
FIGURE 2-3 Karyotype of a normal male. Twenty-three pairs
of chromosomes are shown. The 23rd pair is the XY pair present
in normal males. In normal females, the 23rd pair is XX. For this
karyotype, the chromosomes were treated with chemicals so that
bands of light and dark areas are seen.
If a baby is born with a chromosomal abnormality, serious problems
can result. In Down syndrome, the karyotype shows 47 chromosomes
instead of the normal number, 46 (Figure 2-4). The extra chromosome 21
results in the development of a child with Down syndrome (also called
trisomy 21 syndrome). Its incidence is about 1 in every 750 live births,
but as the mother's age increases, the presence of the chromosomal
abnormality increases.
102
FIGURE 2-4 A, Karyotype of a Down syndrome female
patient showing trisomy 21. There is an extra copy of
chromosome 21, in addition to the usual pair, for a total of three
(tri-). B, Photograph of a child with the typical facial appearance
in Down syndrome. Features include a small, somewhat flat nose
and upward slant of the eyes. Other characteristics of patients
with Down syndrome are mental deficiency and heart defects.
Continue labeling Figure 2-1.
The cytoplasm [4] (cyt/o = cell, -plasm = formation) includes all of the
material outside the nucleus and enclosed by the cell membrane. It
carries on the work of the cell (e.g., in a muscle cell, it does the
contracting; in a nerve cell, it transmits impulses). The cytoplasm
contains specialized apparatus to supply the chemical needs of the cell.
Mitochondria [a] are small sausage-shaped bodies that provide the
principal source of energy for the cell. They use nutrients and oxygen to
release energy that is stored in food. During the chemical process called
catabolism, complex foods such as sugar and fat are broken down (catameans down) into simpler substances and energy is released by the
mitochondria. Thus, catabolism provides the energy for cells to do the
work of the body.
The endoplasmic reticulum [b] is a network (reticulum) of canals
within the cell. These canals are cellular tunnel systems that
manufacture proteins for the cell. A ached to the endoplasmic
reticulum are ribosomes, which build long chains of proteins.
Anabolism, occurring on the endoplasmic reticulum, is the process of
building up (ana- means up) large proteins from small protein pieces
called amino acids. Examples of important proteins for cell growth are
hormones and enzymes.
Together, these two processes—anabolism and catabolism—make up
the cell's metabolism. Metabolism, then, is the total of the chemical
processes occurring in a cell. If a person has a “fast metabolism,” foods
such as sugar and fat are used up very quickly, and energy is released.
103
If a person has a “slow metabolism,” foods are burned slowly, and fat
accumulates in cells.
Study Section 1
Practice spelling each term, and know its meaning.
anabolism
Process of building up large proteins from small protein pieces called amino
acids. Ana- means up, bol means to cast, and -ism is a process.
catabolism
Process whereby complex nutrients are broken down to simpler substances
and energy is released. Cata- means down, bol means to cast, and -ism is a
process.
cell
Structure surrounding and protecting the cell. It determines what enters and
membrane
leaves the cell.
chromosomes Rod-shaped structures in the nucleus that contain regions of DNA called
genes. There are 46 chromosomes (23 pairs) in every cell except for the egg
and sperm cells, which contain only 23 individual, unpaired chromosomes.
cytoplasm
All of the material that is outside the nucleus and yet contained within the
cell membrane.
DNA
Chemical found within each chromosome. Arranged like a sequence of
recipes in code, it directs the activities of the cell.
endoplasmic Network of canals within the cytoplasm of the cell. Here, large proteins are
reticulum
made from smaller protein pieces.
genes
Regions of DNA within each chromosome.
karyotype
Picture (classification) of chromosomes in the nucleus of a cell. The
chromosomes are arranged in numerical order to determine their number
and structure.
metabolism
Total of the chemical processes in a cell. It includes catabolism and
anabolism.
Meta- means change, bol means to cast, and -ism means a process.
mitochondria Rod-shaped structures in the cytoplasm that provide the principal source of
energy (miniature “power plants”) for the cell. Catabolism is the process
that occurs in mitochondria. (From the Greek mitos meaning thread and
chondrion meaning granule.) HINT: Think of “mighty” mitochondria!
nucleus
Control center of the cell. It contains chromosomes and directs the activities
of the cell.
Anabolic Steroids
These drugs are similar to androgens (male hormones) in their effects
on the body. They build up protein within cells.
Metabolism and the Thyroid Gland
The thyroid gland secretes thyroid hormone (thyroxine, or T4), which
stimulates metabolism in cells. Increased levels of hormone speed up
104
metabolism (increased energy and weight loss) and decreased levels of
hormone slow down metabolism (sluggishness and weight gain).
Differences in Cells
While we have just seen how cells contain similar structures, as they
develop in the embryo, cells change to form many different types. Cells
are different, or specialized, throughout the body to carry out their
individual functions. For example, a muscle cell is long and slender and
contains fibers that aid in contracting and relaxing; an epithelial cell (a
lining and skin cell) may be square and flat to provide protection; a
nerve cell may be long and have various fibrous extensions that aid in
its job of carrying impulses; a fat cell contains large, empty spaces for
fat storage. These are only a few of the many types of cells in the body.
Figure 2-5 illustrates the different sizes and shapes of muscle, epithelial,
nerve, and fat cells. The term that describes this change in cells as they
mature and specialize is differentiation.
FIGURE 2-5 Types of cells. A, muscle cell; B, epithelial cell;
C, nerve cell; and D, fat cell.
Differentiation
105
It's still a scientific mystery why cells with the same DNA change or
specialize into different types of cells in the developing embryo. Factors
are thought to influence genes (DNA), leading to differentiation of cells.
If we can figure out what causes differentiation as they mature, we may
be closer to understanding what happens to cells when they revert to a
more primitive, unspecialized form, as in cancer cells.
Tissues
A tissue is a group of similar cells working together to do a specific job.
A histologist (hist/o = tissue) is a scientist who specializes in the study
of tissues. Several different types of tissue are recognized. Tissues of the
same type may be located in various regions of the body. Figure 2-6
illustrates four types of tissues.
FIGURE 2-6 Types of tissues. A, Epithelial. B, Muscle. C,
Connective tissue (Fat). D, Nerve.
106
Epithelial Tissue
Epithelial tissue, located all over the body, forms the linings of internal
organs, and the outer surface of the skin covering the body. It also lines
exocrine and endocrine glands and is responsible for the secretions that
the glands produce. The term epithelial originally referred to the tissue
on (epi-) the breast nipple (thel/o). Now it describes all tissue that covers
the outside of the body and lines the inner surface of internal organs.
Muscle Tissue
Voluntary muscle is found in arms and legs and parts of the body
where movement is under conscious control. Involuntary muscle, found
in the heart and digestive system, as well as other organs, allows
movement that is not under conscious control. Cardiac muscle is a
specialized type of muscle found only in the heart. Contractions of this
muscle type can be seen as a beating heart in an ultrasound scan of a 6week-old fetus.
Connective Tissue
Examples are adipose (fat) tissue, cartilage (elastic, fibrous tissue
a ached to bones), bone, and blood.
Nerve Tissue
Nerve tissue conducts impulses all over the body.
Organs
Different types of tissue combine to form an organ. For example, an
organ such as the stomach is composed of muscle tissue, nerve tissue,
and glandular epithelial tissue. The medical term for internal organs is
viscera (singular: viscus). Examples of abdominal viscera (organs
located in the abdomen) are the liver, stomach, intestines, pancreas,
spleen, and gallbladder.
Systems
Systems are groups of organs working together to perform complex
functions. For example, the mouth, esophagus, stomach, and small and
large intestines are organs that do the work of the digestive system to
digest food and absorb it into the bloodstream.
Figure 2-7 reviews the difference between cells, tissues, organs and
systems.
107
FIGURE 2-7 Cells, tissues, organs and systems.
The body systems with their individual organs are listed next. Learn
to spell and identify the organs in boldface.
SYSTEM
Digestive
ORGANS
Mouth, pharynx (throat), esophagus (tube from the throat to the
stomach), stomach, intestines (small and large), liver, gallbladder,
pancreas
Urinary or
Kidneys, ureters (tubes from the kidneys to the urinary bladder), urinary
excretory
bladder, urethra (tube from the bladder to the outside of the body)
Respiratory
Nose, pharynx, larynx (voice box), trachea (windpipe), bronchial tubes,
lungs (where the exchange of gases takes place)
Reproductive
Female: Ovaries, fallopian tubes, uterus (womb), vagina, mammary
glands
Male: Testes and associated tubes, urethra, penis, prostate gland
Endocrine
Thyroid gland (in the neck), pituitary gland (at the base of the brain),
sex glands (ovaries and testes), adrenal glands, pancreas (islets of
Langerhans), parathyroid glands
Nervous
Brain, spinal cord, nerves, and collections of nerves
Circulatory
Heart, blood vessels (arteries, veins, and capillaries), lymphatic vessels
and nodes, spleen, thymus gland
Musculoskeletal Muscles, bones, and joints
Skin and sense Skin, hair, nails, sweat glands, and sebaceous (oil) glands; eye, ear, nose,
organs
and tongue
Study Section 2
Practice spelling each term, and know its meaning.
108
adipose
tissue
cartilage
Collection of fat cells.
Flexible connective tissue often a ached to bones at joints. Cartilage forms part
of the external ear and the nose. Rings of cartilage surround the trachea.
epithelial Skin cells that cover the outside of the body and line the internal surfaces of
cells
organs.
histologist Specialist in the study of tissues.
larynx
Voice box; located above the trachea.
(LAHHINT: Think of the word laryngitis, which means inflammation of the
RINKS)
voice box, and may result in losing your voice!
pharynx
Throat. The pharynx serves as the common passageway for food (from the
(FAHmouth going to the esophagus) and air (from the nose to the trachea).
RINKS)
HINT: Note that “y” comes before “n” in both pharynx and larynx.
pituitary
Endocrine gland at the base of the brain.
gland
HINT: Be careful spelling pituitary; it contains 2 i's.
thyroid
Endocrine gland that surrounds the trachea in the neck.
gland
trachea
Windpipe (tube leading from the throat and larynx to the bronchial tubes.)
ureter
One of two tubes, each leading from a single kidney to the urinary
bladder.
HINT: Spelling clue: Ureter has two e's, and there are two ureters.
urethra
Tube from the urinary bladder to the outside of the body.
HINT: Spelling clue: Urethra has one e, and there is only one urethra.
uterus
Womb; the organ that holds the embryo/fetus as it develops.
viscera
Internal organs in the main cavities of the body, especially in the abdomen.
Body Cavities
A body cavity is a space within the body that contains internal organs
(viscera). Label Figure 2-8 as you learn the names of the body cavities.
Some of the important organs contained within those cavities are listed
as well.
109
FIGURE 2-8 Body cavities. Ventral (anterior) cavities are in
the front of the body (blue). Dorsal (posterior) cavities are in the
back (red).
110
CAVITY
ORGANS
Cranial [1] Brain, pituitary gland.
Thoracic
Lungs, heart, esophagus, trachea, bronchial tubes, thymus gland, aorta (large
[2]
artery).
The thoracic cavity is divided into two smaller cavities (Figure 2-9):
a. Pleural cavity—space surrounding each lung. The pleura is a double
membrane that surrounds the lungs and protects them. If the pleura is
inflamed (as in pleuritis or pleurisy), the pleural cavity may fill with fluid.
This is called a pleural effusion.
b. Mediastinum—centrally located space outside of and between the lungs. It
contains the heart, aorta, trachea, esophagus, thymus gland, bronchial tubes,
and many lymph nodes.
Continue labeling Figure 2-8.
Abdominal The peritoneum is the double-folded membrane surrounding the abdominal
[3]
cavity (Figure 2-10). It a aches the abdominal organs to the abdominal
muscles and surrounds each organ to hold it in place. The kidneys are two
bean-shaped organs situated behind the abdominal cavity (retroperitoneal
area) on either side of the backbone (see Figures 2-10 and 2-12). The abdominal
cavity also contains the stomach, small and large intestines, spleen, pancreas,
liver, and gallbladder. The diaphragm (a muscular wall) divides the
abdominal and thoracic cavities (see Figure 2-8).
Pelvic [4]
Portions of the small and large intestines, rectum, urinary bladder, urethra,
and ureters; uterus and vagina in the female.
Spinal [5] Nerves of the spinal cord.
FIGURE 2-9 Thoracic Cavity.
111
FIGURE 2-10 Abdominal (peritoneal) cavity (side view and in
light blue). Notice the peritoneum, which is a membrane
surrounding the organs in the abdominal cavity. If there is
disease of the abdominal organs, fluid may accumulate in the
peritoneal cavity. This fluid is called ascites. The retroperitoneal
area is behind the peritoneum. The kidneys are in the
retroperitoneal area.
The cranial and spinal cavities are the dorsal (dors/o = back) body
cavities because of their location on the back or posterior portion of the
body. The thoracic, abdominal, and pelvic cavities are ventral (ventr/o =
belly) body cavities because they are on the front (anterior) portion of
the body (see Figure 2-8).
While the thoracic and abdominal cavities are separated by a
muscular wall called the diaphragm, the abdominal and pelvic cavities
are not separated and are referred to together as the abdominopelvic
cavity. Figures 2-11 and 2-12 show the abdominal and thoracic viscera
from anterior (ventral) and posterior (dorsal) views.
112
FIGURE 2-11 Organs of the abdominopelvic and thoracic
cavities, anterior view.
113
FIGURE 2-12 Organs of the abdominopelvic and thoracic
cavities, posterior view.
Study Section 3
Practice spelling each term, and know its meaning.
114
abdominal
Space below the chest containing organs such as the liver, stomach,
cavity
gallbladder, and intestines; also called the abdomen or peritoneal cavity.
cranial cavity Space in the head containing the brain and surrounded by the skull. Cranial
means pertaining to the skull.
diaphragm
Muscle separating the abdominal and thoracic cavities. The diaphragm
moves up and down and aids in breathing.
dorsal
Pertaining to the back.
(posterior)
mediastinum Centrally located space outside of and between the lungs.
pelvic cavity Space below the abdomen containing portions of the intestines, rectum,
urinary bladder, and reproductive organs. Pelvic means pertaining to the
pelvis, composed of the hip bones surrounding the pelvic cavity.
peritoneum Double-folded membrane surrounding the abdominal cavity. The
peritoneum a aches abdominal viscera to muscles and functions as a
protective membrane (containing blood vessels and nerves) around the
organs.
pleura
Double-folded membrane surrounding each lung. Pleural means pertaining
to the pleura. HINT: Don't confuse pleural with plural, which means more
than one!
pleural
Space between the pleural layers.
cavity
spinal cavity Space within the spinal column (backbones) containing the spinal cord. See
Figure 2-13.
thoracic
Space in the chest containing the heart, lungs, bronchial tubes, trachea,
cavity
esophagus, and other organs.
ventral
Pertaining to the front.
(anterior)
FIGURE 2-13 Spinal Cavity. A disc is a pad of cartilage that
acts as a cushion between each backbone of the spinal column.
Peritoneum and Other Membranes
115
Many vital organs are covered and protected by membranes. The
peritoneum surrounds abdominal viscera (liver, small and large
intestines, stomach), and the pleura covers the lungs.
You can visualize the way organs are surrounded by a double
membrane by imagining your fist pushing deep into a soft balloon. The
balloon is then in two layers folded over your fist, just the way the
pleura surrounds the lungs and the peritoneum surrounds the
abdominal organs. Double wrapping around organs provides
protection and cushioning, as well as a site for a achment to muscles.
In the event of inflammation or disease of organs or membranes, fluid
may collect in the space between the membranes surrounding the
organs. This collection of fluid in the pleural cavity is called a pleural
effusion. A collection of fluid in the peritoneal cavity is called ascites.
116
Abdominopelvic Regions and
Quadrants
Regions
Doctors divide the abdominopelvic area into nine regions. Label these
regions in Figure 2-14.
FIGURE 2-14 Abdominopelvic regions. These regions can be
used clinically to locate internal organs.
Right hypochondriac region [1]: right upper region below (hypo-)
the cartilage (chondr/o) of the ribs that extend over the abdomen
Left hypochondriac region [2]: left upper region below the rib
cartilage
Epigastric region [3]: region above the stomach
Right lumbar region [4]: right middle region near the waist
Left lumbar region [5]: left middle region near the waist
Umbilical region [6]: region of the navel or umbilicus
Right inguinal region [7]: right lower region near the groin
(inguin/o = groin), which is the area where the legs join the trunk
117
of the body. This region also is known as the right iliac region
because it lies near the ilium (the upper portion of the hip bone).
Left inguinal region [8]: left lower region near the groin. Also
called the left iliac region.
Hypogastric region [9]: middle lower region below the umbilical
region.
Quadrants
The abdominopelvic area can be divided into four quadrants by two
imaginary lines—one horizontal and one vertical—that cross at the
midsection of the body. Figure 2-15 shows the four abdominopelvic
quadrants; add the proper abbreviation on the line under each label on
the diagram.
118
FIGURE 2-15 Abdominopelvic quadrants. Write the
abbreviation for each quadrant on the line provided.
Right upper quadrant (RUQ)—contains the liver (right lobe),
gallbladder, part of the pancreas, parts of the small and large
intestines
Left upper quadrant (LUQ)—contains the liver (left lobe), stomach,
spleen, part of the pancreas, parts of the small and large
intestines
Right lower quadrant (RLQ)—contains parts of the small and large
intestines, right ovary, right fallopian tube, appendix, right ureter
Left lower quadrant (LLQ)—contains parts of the small and large
intestines, left ovary, left fallopian tube, left ureter
119
Divisions of the Back (Spinal Column)
The spinal column is composed of a series of bones that extend from the
neck to the tailbone. Each bone is a vertebra (plural: vertebrae).
Label the divisions of the back on Figure 2-16A as you study the
following:
FIGURE 2-16 A, Anatomic divisions of the back (spinal
column). A disc is a small pad of cartilage between each
backbone. B, MRI (magnetic resonance image) of a herniated
disc at the L4-L5 level of the spinal column.
120
DIVISION OF
ABBREVIATION LOCATION
THE BACK
Cervical [1]
C
Neck region. There are seven cervical vertebrae (C1 to
C7).
Thoracic [2]
T
Chest region. There are 12 thoracic vertebrae (T1 to
T12). Each bone is joined to a rib.
Lumbar [3]
L
Loin (waist) or flank region (between the ribs and the
hipbone). There are five lumbar vertebrae (L1 to L5).
Sacral [4]
S
Five bones (S1 to S5) are fused to form one bone, the
sacrum.
Coccygeal [5]
The coccyx (tailbone) is a small bone composed of four
fused pieces.
Do not confuse the spinal column (backbones or vertebrae) with the
spinal cord (nerves surrounded by the column). The spinal column is
bone tissue, whereas the spinal cord is nervous tissue.
The spaces between the vertebrae (intervertebral spaces) are
identified according to the two vertebrae between which they occur—
for example, the L5–S1 space is between the fifth lumbar vertebra and
the first sacral vertebra; T2–3 is between the second and third thoracic
vertebrae. Within the space and between vertebrae is a small pad called
a disc. The disc, composed of water and cartilage, is a shock absorber.
Occasionally, a disc may move out of place (herniate) and put pressure
on a nerve (see Figure 2-16B). This “slipped disc” can cause pain in an
area of the body affected by the nerve.
Study Section 4
Practice spelling each term, and know its meaning.
Abdominopelvic Regions
hypochondriac
epigastric
lumbar
umbilical
inguinal
hypogastric
Right and left upper regions beneath the ribs.
Middle upper region above the stomach.
Right and left middle regions near the waist.
Central region near the navel.
Right and left lower regions near the groin. Also called iliac regions.
Middle lower region below the umbilical region.
Abdominopelvic Quadrants
RUQ
LUQ
RLQ
LLQ
Right upper quadrant.
Left upper quadrant.
Right lower quadrant.
Left lower quadrant.
Divisions of the Back
121
cervical
thoracic
lumbar
sacral
coccygeal
Neck region (C1 to C7).
Chest region (T1 to T12).
Loin (waist) region (L1 to L5).
Region of the sacrum (S1 to S5).
Region of the coccyx (tailbone).
Related Terms
vertebra
vertebrae
spinal column
spinal cord
disc
Single backbone. HINT: There are two e's in vertebra
Backbones. (VER-teh-bray)
Bone tissue surrounding the spinal cavity.
Nervous tissue within the spinal cavity.
Pad of cartilage between vertebrae.
122
Positional and Directional Terms
Label Figure 2-17 to identify the following positional and directional
terms.
123
FIGURE 2-17 Positional and directional terms. Note that the
standing figure is in the anatomic position, with the palms of the
hands facing outward and the fifth (little) finger in a medial
position (closer to the center of the body). The thumb is lateral.
124
LOCATION
Anterior
(ventral)
[1]
Posterior
(dorsal) [2]
Deep [3]
RELATIONSHIP
Front side of the body. Example: The forehead is on the anterior (ventral) side
of the body.
Back side of the body. Example: The back of the head is posterior (dorsal) to
the face.
Away from the surface. Example: The stab wound penetrated deep into the
abdomen.
On the surface. Example: Superficial veins can be viewed through the skin.
Superficial
[4]
Proximal [5] Near the point of a achment to the trunk or near the beginning of a
structure. Example: The proximal end of the thigh bone (femur) joins with the
hip socket.
Distal [6]
Far from the point of a achment to the trunk or far from the beginning of a
structure. Example: At its distal end, the femur joins with the knee.
Inferior [7] Below another structure. Example: The feet are at the inferior part of the
body. They are inferior to the knees.
Superior [8] Above another structure. Example: The head lies superior to the neck.
Cephalic (pertaining to the head) also means above another structure.
Medial [9]
Pertaining to the middle, or nearer the medial plane of the body. Example:
When in the anatomic position (palms of the hands facing outward), the fifth
(li le) finger is medial.
Lateral [10] Pertaining to the side. Example: When in the anatomic position (palms of the
hands facing outward), the thumb is lateral.
Supine [11] Lying on the back. Example: The patient lies supine during an examination of
the abdomen and, in females, during a pelvic (gynecologic) exam. See Figure
2-21 on page 62.
Prone [12]
Lying on the belly. Example: The backbones are examined with the patient in
a prone position. A patient lies on his/her stomach in the prone position.
125
Planes of the Body
A plane is an imaginary flat surface. Label Figure 2-18 to identify the
following planes of the body:
FIGURE 2-18 Planes of the body. The figure is in the
anatomic position. Note the views of the body represented by
each plane.
126
PLANE
Frontal
(coronal)
plane [1]
Sagi al
(lateral)
plane [2]
Transverse
(axial)
plane [3]
LOCATION
Vertical plane dividing the body or structure into anterior and posterior
portions. A common chest x-ray view is a PA (posteroanterior—viewed from
back to front) view, which is in the frontal (coronal) plane. See Figure 2-18.
Lengthwise vertical plane dividing the body or structure into right and left
sides. The midsagi al plane divides the body into right and left halves. A
lateral (side-to-side) chest x-ray film is taken in the sagi al plane.
Horizontal (cross-sectional) plane running across the body parallel to the
ground. This cross-sectional plane divides the body or structure into upper
and lower portions. A CT (computed tomography) scan is one of a series of xray pictures taken in the transverse (axial or cross-sectional) plane.
Study Section 5
Practice spelling each term, and know its meaning.
anterior
(ventral)
deep
distal
frontal
(coronal)
plane
inferior
lateral
medial
posterior
(dorsal)
prone
proximal
sagi al
(lateral)
plane
Front surface of the body.
Away from the surface.
Far from the point of a achment to the trunk or far from the beginning of a
structure.
Vertical plane dividing the body or structure into anterior and posterior
portions.
Below another structure; pertaining to the lower portion of the body.
Pertaining to the side.
Pertaining to the middle or near the medial plane of the body.
Back surface of the body.
Lying on the belly (face down, palms down).
Near the point of a achment to the trunk or near the beginning of a structure.
Lengthwise, vertical plane dividing the body or structure into right and left
sides. From the Latin sagi a, meaning arrow. As an arrow is shot from a bow it
enters the body in the sagi al plane, dividing right from left. The midsagi al
plane divides the body into right and left halves.
superficial On the surface.
superior
Above another structure; pertaining to the head.
(cephalic)
supine
Lying on the back (face up, palms up). HINT: Lying supine is on your spine
transverse Horizontal (cross-sectional) plane dividing the body into upper and lower
(axial)
portions.
plane
Terminology
Divide each term into its component parts, and write its meaning in the
space provided.
127
Combining Forms
FIGURE 2-19 The cervix is the lower portion or neck of the
uterus.
FIGURE 2-20
128
COMBINING
MEANING TERMINOLOGY
MEANING
FORM
abdomin/o
abdomen
abdominal
The abdomen is the region below the chest containing internal
organs (such as the liver, intestines, stomach, and gallbladder).
adip/o
fat
adipose
The suffix -ose means pertaining to or full of. Another
combining form meaning fat is lip/o. Lipids are fats.
anter/o
front
anterior
The suffix -ior means pertaining to.
cervic/o
neck (of the
cervical
body or of
The cervix is the neck of the uterus. See Figure 2-19.
the uterus)
chondr/o
cartilage
chondroma
(type of
This is a benign tumor.
connective
chondrosarcoma
tissue)
This is a malignant tumor. The root sarc indicates that the
malignant tumor arises from a type of flesh or connective tissue.
chrom/o
color
chromosomes
These nuclear structures absorb the color of dyes used to stain
the cell. The suffix -somes means bodies. Literally, this term
means “bodies of color,” because this is how they appeared to
researchers who first saw them under the microscope.
coccyg/o
coccyx
coccygeal
(tailbone)
crani/o
skull
craniotomy
cyt/o
cell
cytoplasm
The suffix -plasm means formation.
dist/o
far, distant distal
dors/o
back
dorsal
portion of
the body
hist/o
tissue
histology
ili/o
ilium
iliac
(upper part
See Figure 2-20 for a picture of the ilium.
of the hip
bone)
inguin/o
groin
inguinal
kary/o
nucleus
karyotype
The suffix -type means classification or picture.
later/o
side
lateral
lumb/o
lower back lumbosacral
medi/o
middle
medial
nucle/o
nucleus
nucleic
pelv/i
pelvis
pelvic
The pelvis includes all the bones that surround the pelvic
cavity (Figure 2-20).
pharyng/o
pharynx
pharyngeal
(throat)
The pharynx (FAH-rinks) is the common passageway for food
from the mouth and air from the nose.
poster/o
back,
posterior
behind
proxim/o
nearest
proximal
sacr/o
sacrum
sacral
129
COMBINING
MEANING TERMINOLOGY
MEANING
FORM
sarc/o
flesh
sarcoma
spin/o
spine,
spinal
backbone
thel/o, theli/o nipple
epithelial cell
This cell, originally identified in the skin of the nipples, lies on
body surfaces, externally (outside the body) and internally
(lining cavities and organs).
thorac/o
chest
thoracic
thoracotomy
trache/o
trachea,
tracheal
windpipe
umbilic/o
navel,
umbilical
umbilicus
ventr/o
belly side
ventral
of the body
vertebr/o
vertebra(e), vertebral
backbone(s)
viscer/o
internal
visceral
organs
Prefixes
PREFIX MEANING TERMINOLOGY
MEANING
anaup
anabolism
In this cellular process, proteins are built up from simpler substances
(amino acids).
catadown
catabolism
Complex nutrients are broken down into simpler substances and
energy is released.
epiabove
epinephrine
The suffix -ine means a substance. Epinephrine is a hormone secreted
by the adrenal glands, located above (epi-) the kidneys (nephr/o). It is
used as a treatment (as with an EpiPen®) for severe allergic reactions.
It opens airways and increases heart rate in medical emergencies.
hypobelow
hypochondriac region
The Greeks thought that organs (liver and spleen) in the hypochondriac
region of the abdomen were the origin of imaginary illnesses—hence
the term hypochondriac, a person with unusual anxiety about his or
her health and with symptoms not a ributable to any disease process.
interbetween
intervertebral
A disc is an intervertebral structure.
intrawithin
intravenous
The abbreviation for intravenous is IV.
metachange
metabolism
Literally, to cast (bol/o) a change (meta-), meaning the chemical
changes (processes) that occur in a cell.
Suffixes
130
The following are some new suffixes introduced in this chapter. See the
Glossary (Medical Word Parts—English) at the end of the book for
additional suffixes meaning “pertaining to.”
SUFFIX
-eal
-iac
-ior
-ism
-ose
-plasm
-somes
-type
MEANING
pertaining to
pertaining to
pertaining to
process, condition
pertaining to, full of
formation
bodies
picture, classification
Cervical
The term cervical can have two different meanings depending on
where it is used. In a gynecologic report, cervical means the lower
portion or neck of the uterus (cervix). In a spinal radiologic report
about cervical vertebrae, cervical refers to the neck of the body.
Pelvis
Comparison of Female and Male
The female pelvis is wider and more massive than the male pelvis.
The female pelvic opening is a larger, rounded, oval shape, whereas the
male pelvic opening is deep, narrow, and funnel- or heart-shaped.
Thus, the female pelvis can accommodate the fetus during pregnancy
and its downward passage through the pelvic cavity in childbirth.
Epinephrine and Adrenaline
These are the SAME hormone! Two different names for the same
substance secreted by the adrenal glands (above the kidneys).
Practical Applications
Be sure to check your answers with the Answers to Practical
Applications on page 64.
131
X-ray Views
Circle the correct answers in the following sentences related to each xray view of the chest.
132
FIGURE A
1. This is a/an (coronal,
sagi al, axial) view. The
heart lies (anterior,
posterior, dorsal) to the
vertebrae.
FIGURE B
2. This is a/an (coronal,
sagi al, axial) view. It is
a/an (CT, traditional xray) image.
FIGURE C
3. This is a/an (coronal,
sagi al, axial) view. It is
a/an (lateral, transverse,
anterior/posterior)
image.
Surgical Procedures
133
Match the surgical procedure in Column I with an indication for
performing it in Column II. Note: You are not looking for the exact
meaning of each surgical procedure, but rather why it would be
performed.
COLUMN I
Procedures
1. Craniotomy
2. Thoracotomy
3. Discectomy
4. Mediastinoscopy
5. Tracheotomy
6. Laryngectomy
7. Arthroscopy
8. Laparoscopy
(peritoneoscopy)
*Lymph
†A
_______
_______
_______
_______
_______
_______
_______
_______
COLUMN II
Indications
A. Emergency effort to remove foreign material from the
windpipe
B. Inspection and repair of torn cartilage in the knee
C. Removal of a diseased or injured portion of the brain
D. Inspection of lymph nodes* in the region between the
lungs
E. Removal of a squamous cell† carcinoma in the voice box
F. Open heart surgery, or removal of lung tissue
G. Inspection of abdominal organs (lapar/o means
abdomen) and removal of diseased tissue
H. Relief of symptoms from a bulging intervertebral disc
nodes are collections of tissue containing white blood cells called lymphocytes.
squamous cell is a type of epithelial cell.
134
Exercises
Remember to check your answers carefully with the Answers to
Exercises, page 63.
A The listed terms are parts of a cell. Match each term
with its correct meaning.
cell membrane
chromosomes
cytoplasm
DNA
endoplasmic reticulum
genes
mitochondria
nucleus
1. material of the cell located outside the nucleus and
yet enclosed by the cell membrane
_____________________________________________
_____________________________________
2. regions of DNA within each chromosome
_____________________________________________
__
3. small sausage-shaped structures that are the
principal source of energy for the cell
_____________________________________________
_____________________________________
4. network of canals within the cytoplasm; the site of
protein synthesis _________________________
5. structure that surrounds and protects the cell
___________________________________________
6. control center of the cell, containing chromosomes
_______________________________________
135
7. chemical found within each chromosome
_____________________________________________
__
8. rod-shaped structures in the nucleus that contain
regions called genes _______________________
B Use medical terms or numbers to complete the
following sentences.
1. A picture of chromosomes in the nucleus of a cell is
a/an _________________________________.
2. The number of chromosomes in a normal male's
muscle cell is ____________________________.
3. The number of chromosomes in a female's egg cell
is ____________________________________.
4. The process of building up proteins in a cell is
__________________________________________.
5. Complex nutrients are broken down to similar
substances and energy is released
_____________________________________________
____________________________________.
6. The total of the chemical processes in a cell is
__________________________________________.
7. A scientist who studies tissues is a/an
_____________________________________________
____.
8. The medical term for internal organs is
_____________________________________________
___.
C Match the listed body parts or tissues with their
correct descriptions that follow.
adipose tissue
136
cartilage
epithelial tissue
larynx
pharynx
pituitary gland
pleura
thyroid gland
trachea
ureter
urethra
uterus
1. voice box
_____________________________________________
____________________________
2. membrane surrounding the lungs
_____________________________________________
________
3. throat
_____________________________________________
_______________________________
4. tube from the kidney to the urinary bladder
____________________________________________
5. collection of fat cells
_____________________________________________
___________________
6. endocrine organ located at the base of the brain
_________________________________________
7. windpipe
_____________________________________________
____________________________
137
8. flexible connective tissue a ached to bones at joints
_____________________________________
9. skin cells that cover the outside of the body and
line internal organs ________________________
10. endocrine gland surrounding the windpipe in the
neck ___________________________________
11. womb
_____________________________________________
_______________________________
12. tube leading from the urinary bladder to the
outside of the body ___________________________
D Name the five cavities of the body.
1. cavity surrounded by the skull
_____________________________________________
___________
2. cavity in the chest surrounded by the ribs
_____________________________________________
_
3. cavity below the chest containing the stomach,
liver, and gallbladder ________________________
4. cavity surrounded by the hip bones
_____________________________________________
_______
5. cavity surrounded by the bones of the back
_____________________________________________
E Select from the following to define the terms listed.
space surrounding each lung
space between the lungs
muscle separating the abdominal and thoracic
cavities
138
membrane surrounding the abdominal organs
area below the umbilicus (as well as below the
stomach)
area above the stomach
area of the navel
areas near the groin
nervous tissue within the spinal cavity
bony tissue surrounding the spinal cavity
pad of cartilage between two adjoining vertebrae
1. hypogastric region
_____________________________________________
____________________
2. mediastinum
_____________________________________________
_________________________
3. spinal cord
_____________________________________________
___________________________
4. diaphragm
_____________________________________________
___________________________
5. intervertebral disc
_____________________________________________
____________________
6. pleural cavity
_____________________________________________
_________________________
7. spinal column
_____________________________________________
________________________
139
8. inguinal regions
_____________________________________________
______________________
9. peritoneum
_____________________________________________
__________________________
10. umbilical region
_____________________________________________
______________________
11. epigastric region
_____________________________________________
______________________
F Name the five divisions of the back.
1. region of the neck
_____________________________________________
_____________________
2. region of the chest
_____________________________________________
____________________
3. region of the waist
_____________________________________________
_____________________
4. region of the sacrum
_____________________________________________
___________________
5. region of the tailbone
_____________________________________________
__________________
G Give the meanings of the following abbreviations.
140
1. LLQ
_____________________________________________
_________________________________
2. L5–S1
_____________________________________________
_______________________________
3. RUQ
_____________________________________________
________________________________
4. C3–C4
_____________________________________________
_______________________________
5. RLQ
_____________________________________________
________________________________
H Give the opposites of the following terms.
1. deep _______________________________
2. proximal ____________________________
3. supine ______________________________
4. medial ______________________________
5. dorsal ______________________________
6. superior ____________________________
I Select from the following medical terms to complete
the sentences below.
distal
frontal (coronal)
inferior
lateral
midsagi al
141
proximal
superior (cephalic)
transverse (axial)
vertebra
vertebrae
1. The kidney lies to side of or
______________________ of the spinal cord.
2. The ___________ end of the thigh bone (femur)
joins with the kneecap (patella).
3. The ___________ plane divides the body into an
anterior and a posterior portion.
4. Each backbone is a/an
_____________________________________________
______________.
5. Several backbones are
_____________________________________________
______________.
6. The diaphragm lies __________________________
to the organs in the thoracic cavity.
7. The __________________________ plane divides the
body into right and left halves.
8. The ______________________ end of the upper arm
bone (humerus) is at the shoulder.
9. The ________________________ plane divides the
body into upper and lower portions.
10. The pharynx is located
____________________________________________
to the esophagus.
J Give meanings for each of the following.
142
1. craniotomy
_____________________________________________
___________________________
2. cervical
_____________________________________________
______________________________
3. chondroma
_____________________________________________
___________________________
4. chondrosarcoma
_____________________________________________
_______________________
5. nucleic
_____________________________________________
______________________________
6. epinephrine
_____________________________________________
__________________________
7. intravenous
_____________________________________________
__________________________
8. pharyngeal
_____________________________________________
___________________________
9. laryngitis
_____________________________________________
____________________________
K Give the medical term for the following definitions.
Pay a ention to spelling!
1. space below chest containing liver, stomach,
gallbladder, and intestines _____________________
143
2. flexible connective tissue a ached to bones at joints
_____________________________________
3. rod-shaped structures in the cell nucleus,
containing regions of DNA
_______________________
4. muscle separating the abdominal and thoracic
cavities ___________________________________
5. voice box
_____________________________________________
___________________________
6. vertical plane dividing the body into right and left
sides __________________________________
7. pertaining to the neck
_____________________________________________
_________________
8. tumor (benign) of cartilage
_____________________________________________
____________
9. control center of the cell; directs the activities of the
cell _________________________________
10. pertaining to the windpipe
_____________________________________________
_____________
L Complete each term based on the meaning
provided.
1. pertaining to internal organs:
__________________________ al
2. tumor of flesh tissue (malignant):
__________________________ oma
144
3. pertaining to the chest:
__________________________ ic
4. picture of the chromosomes in the cell nucleus:
__________________________ type
5. sausage-shaped cellular structures in which
catabolism takes place: mito ___________________
6. space between the lungs: media
__________________________
7. endocrine gland at the base of the brain:
__________________________ ary gland
8. pertaining to skin (surface) cells: epi
__________________________
9. pertaining to far from the beginning of a structure:
__________________________ al
10. on the surface of the body: super
__________________________
M Circle the correct term to complete each sentence.
1. Dr. Curnen said the (inguinal, superior,
superficial) wound barely scratched the surface.
2. Because the liver and spleen are on opposite sides
of the body, the liver is in the (RUQ, LUQ, LLQ) of
the abdominopelvic cavity and the spleen is in the
(RUQ, LUQ, RLQ).
3. When a gynecologist performs a pelvic
examination, the patient lies on her back in the
(ventral, dorsal, medial) lithotomy position
(Figure 2-21).
145
FIGURE 2-21 Dorsal lithotomy position. Lithotomy means
incision to remove a stone (lith/o = stone). This supine position is
used for pelvic (gynecologic) examinations and for removal of
stones from the urinary tract.
4. Sally complained of pain in the area surrounding
her navel. The doctor described the pain as
(periumbilical, epigastric, hypogastric).
5. After sampling the fluid surrounding her 16-weekold fetus and reviewing the chromosomal picture,
the doctor explained to Mrs. Jones that the fetus
had trisomy 21. The diagnosis was made by
analysis of an abnormal (urine sample, x-ray film,
karyotype).
6. The (spinal, sagi al, abdominal) cavity contains
digestive organs.
7. The emergency department physician suspected
appendicitis when Brandon was admi ed with
sharp (LLQ, RLQ, RUQ) pain.
8. Susan had hiccups after rapidly eating spicy Indian
food. Her physician explained that the hiccups
were involuntary contractions or spasms of the
(umbilicus, diaphragm, mediastinum), resulting
in uncontrolled breathing in of air.
9. Maria's coughing and sneezing were a result of an
allergy to animal dander that affected her
(respiratory, cardiovascular, urinary) system.
146
10. While ice skating, Natalie fell and landed on her
bu ocks. She had persistent (cervical, thoracic,
coccygeal) pain for a few weeks but no broken
bones on x-ray examination.
147
Answers to Exercises
A
1. cytoplasm
2. genes
3. mitochondria
4. endoplasmic reticulum
5. cell membrane
6. nucleus
7. DNA
8. chromosomes
B
1. karyotype
2. 46 (23 pairs)
3. 23
4. anabolism
5. catabolism
6. metabolism
7. histologist
8. viscera
C
1. larynx
2. pleura
148
3. pharynx
4. ureter
5. adipose tissue
6. pituitary gland
7. trachea
8. cartilage
9. epithelial tissue
10. thyroid gland
11. uterus
12. urethra
D
1. cranial
2. thoracic
3. abdominal
4. pelvic
5. spinal
E
1. area below the umbilicus
2. space between the lungs
3. nervous tissue within the spinal cavity
4. muscle separating the abdominal and thoracic
cavities
5. pad of cartilage between two adjoining vertebrae
149
6. space surrounding each lung
7. bony tissue surrounding the spinal cavity
8. areas near the groin
9. membrane surrounding the abdominal organs
10. area of the navel
11. area above the stomach
F
1. cervical
2. thoracic
3. lumbar
4. sacral
5. coccygeal
G
1. left lower quadrant (of the abdominopelvic cavity)
2. between the fifth lumbar vertebra and the first sacral
vertebra (a common place for a herniated disc)
3. right upper quadrant (of the abdominopelvic cavity)
4. between the third and fourth cervical vertebrae
5. right lower quadrant (of the abdominopelvic cavity)
H
1. superficial
2. distal
3. prone
150
4. lateral
5. ventral (anterior)
6. inferior
I
1. lateral
2. distal
3. frontal (coronal)
4. vertebra
5. vertebrae
6. inferior
7. midsagi al
8. proximal
9. transverse (axial)
10. superior (cephalic)
J
1. craniotomy—incision of the skull
2. cervical—pertaining to the neck of the body or the
cervix of the uterus
3. chondroma—tumor of cartilage (benign or
noncancerous tumor)
4. chondrosarcoma—flesh tumor of cartilage
(cancerous, malignant tumor)
5. nucleic—pertaining to the nucleus
151
6. epinephrine—substance (hormone) secreted by the
adrenal glands (epi- = above; nephr- = kidney)
7. intravenous—pertaining to within a vein
8. pharyngeal—pertaining to the pharynx (throat)
9. laryngitis—inflammation of the larynx (voice box)
K
1. abdomen or abdominal cavity
2. cartilage
3. chromosomes
4. diaphragm
5. larynx
6. sagi al—note spelling with two t's
7. cervical
8. chondroma
9. nucleus
10. tracheal
L
1. visceral
2. sarcoma
3. thoracic
4. karyotype
5. mitochondria—memory tip: catabolism and
mitochondria, cat and mouse!
152
6. mediastinum
7. pituitary gland
8. epithelial
9. distal
10. superficial
M
1. superficial
2. RUQ; LUQ
3. dorsal; often called the dorsolithotomy position
4. periumbilical
5. karyotype
6. abdominal
7. RLQ
8. diaphragm
9. respiratory
10. coccygeal
Answers to Practical Applications
X-ray Views
1. sagi al, anterior
2. axial, CT
3. coronal, anterior/posterior
Surgical Procedures
153
1. C A trephine is a type of circular saw used for
craniotomy.
2. F
3. H Endoscopic discectomy is performed through a
small incision on the back, lateral to the spine. All or
a portion of the disc is removed.
4. D A small incision is made above the breastbone and
an endoscope is inserted to inspect the lymph nodes
around the trachea.
5. A
6. E
7. B
8. G A small incision is made near the navel, and a
laparoscope is inserted. Laparoscopy, or minimally
invasive surgery, is used to examine organs and
perform many surgical operations, such as removal
of the gallbladder or appendix or tying off of the
fallopian tubes. Laparoscopy is also called
peritoneoscopy.
Pronunciation of Terms
The terms you have learned in this chapter are presented here with
their pronunciations. The CAPITAL le ers indicate the accented
syllable.
The meanings for all the terms are in the Mini-Dictionary beginning
on page 897. You can also hear each term pronounced on the Evolve
website (h p://evolve.elsevier.com/Chabner/language/).
154
TERM
abdomen
abdominal cavity
adipose
anabolism
anterior
cartilage
catabolism
cell membrane
cephalic
cervical
chondroma
chondrosarcoma
chromosome
coccygeal
coccyx
cranial cavity
craniotomy
cytoplasm
deep
diaphragm
disc
distal
dorsal
endoplasmic reticulum
epigastric region
epinephrine
epithelial cells
frontal plane
genes
histology
hypochondriac regions
hypogastric region
iliac
inferior
inguinal regions
intervertebral
intravenous
karyotype
laryngitis
larynx
lateral
lumbar regions
lumbar spine
lumbosacral
medial
mediastinum
metabolism
mitochondria
nucleic
nucleus
pelvic cavity
peritoneum
PRONUNCIATION
AB-do-men
ab-DOM-ih-nal KAV-ih-te
AH-dih-pohs
ah-NAB-o-liz-im
an-TE-re-or
KAR-tih-lij
kah-TAB-o-liz-im
sel MEM-brayn
seh-FAL-ik
SER-vih-kul
kon-DRO-mah
kon-dro-sar-KO-mah
KRO-mo-sohm
kok-sih-JE-al
KOK-siks
KRA-ne-al KAV-ih-te
kra-ne-OT-o-me
SI-to-plaz-im
deep
DI-ah-fram
disk
DIS-tal
DOR-sal
en-do-PLAZ-mik reh-TIK-u-lum
ep-ih-GAS-trik RE-jen
ep-ih-NEF-rin
ep-ih-THE-le-al sels
FRUN-tal playn
jeenz
his-TOL-o-je
hi-po-KON-dre-ak RE-jens
hi-po-GAS-trik RE-jen
IL-e-ak
in-FE-re-or
IN-gwih-nal RE-jens
in-ter-ver-TE-bral
in-trah-VE-nus
KAIR-e-o-type
lah-rin-JI-tis
LAH-rinks
LAT-er-al
LUM-bar RE-jens
LUM-bar spine
lum-bo-SA-kral
ME-de-al
me-de-ah-STI-num
meh-TAB-o-lism
mi-to-KON-dre-ah
nu-CLA-ik
NU-cle-us
PEL-vik KAV-ih-te
per-eh-to-NE-um
155
TERM
pharyngeal
pharynx
pituitary gland
pleura
pleural cavity
posterior
prone
proximal
sacral
sacrum
sagi al plane
sarcoma
spinal cavity
spinal column
spinal cord
superficial
superior
supine
thoracic cavity
thoracotomy
thyroid gland
trachea
tracheal
transverse plane
umbilical region
ureter
urethra
uterus
ventral
vertebra
vertebrae
vertebral
viscera
visceral
PRONUNCIATION
fah-ren-JE-al
FAH-rinks
pih-TU-ih-ter-e gland
PLUR-ah
PLUR-al KAV-ih-te
pos-TE-re-or
prohn
PROKS-ih-mal
SA-kral
SA-krum
SAJ-ih-tal playn
sar-KO-mah
SPI-nal KAV-ih-te
SPI-nal KOL-um
SPI-nal kord
su-per-FIH-shul
su-PE-re-or
su-PINE
thor-AH-sik KAV-ih-te
thor-ah-KOT-o-me
THI-royd gland
TRA-ke-ah
TRA-ke-al
tranz-VERS playn
um-BIL-ih-kal RE-jen
U-reh-ter
u-RE-thrah
U-ter-us
VEN-tral
VER-teh-brah
VER-teh-bray
ver-TE-bral
VIS-er-ah
VIS-er-al
Review Sheet
Write the meaning of each combining form, prefix, or suffix in the space
provided, and test yourself. Check your answers with the information
in the chapter or in the Glossary (Medical Word Parts—English), at the
end of the book.
Combining Forms
156
COMBINING FORM
abdomin/o
adip/o
anter/o
cervic/o
chondr/o
chrom/o
coccyg/o
crani/o
cyt/o
dist/o
dors/o
hist/o
ili/o
inguin/o
kary/o
laryng/o
later/o
lumb/o
medi/o
nucle/o
pelv/i
pharyng/o
poster/o
proxim/o
sacr/o
sarc/o
spin/o
thel/o, theli/o
thorac/o
trache/o
umbilic/o
ventr/o
vertebr/o
viscer/o
MEANING
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
Prefixes
PREFIX
anacataepihypointermeta-
MEANING
___________________
___________________
___________________
___________________
___________________
___________________
Suffixes
157
SUFFIX
-al
-eal
-ectomy
-iac
-ior
-ism
-oma
-ose
-plasm
-somes
-tomy
-type
MEANING
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
Label the regions and quadrants (use abbreviations) of the
abdominopelvic cavity. Check your answers in the chapter, pages 46
and 47.
Name the divisions of the spinal column. Check your answers on
page 48.
neck region (C1 to C7)
__________________________________________________________
____________
chest region (T1 to T12)
__________________________________________________________
_________
lower back (loin) region (L1 to L5)
__________________________________________________________
_
region of the sacrum (S1 to S5)
__________________________________________________________
___
tailbone region
__________________________________________________________
__________________
158
Name the planes of the head as pictured below. Check your
answers on page 52.
vertical plane that divides the body into anterior and posterior
portions
__________________________________________________________
_____________
horizontal plane that divides the body into upper and lower
portions
__________________________________________________________
_____________
vertical plane that divides the body into right and left portions
__________________________________________________________
_____________
Name the positional and directional terms. Check your answers on
pages 50-51.
front of the body
__________________________________________________________
_________________
159
back of the body
__________________________________________________________
__________________
away from the surface of the body
__________________________________________________________
_
on the surface of the body
__________________________________________________________
________
far from the point of a achment to the trunk or far from the
beginning of a structure
__________________________________________________________
______________________________
near the point of a achment to the trunk or near the beginning of
a structure
__________________________________________________________
______________________________
below another structure
__________________________________________________________
_______________
above another structure
__________________________________________________________
____________
pertaining to the side
__________________________________________________________
_____________
pertaining to the middle
__________________________________________________________
_____________
lying on the belly
__________________________________________________________
________________
lying on the back
__________________________________________________________
_______________
Give the meanings of the following terms that pertain to the cell.
Check your answers with Study Section 1, page 35.
chromosomes
__________________________________________________________
______________
160
mitochondria
__________________________________________________________
_________________
nucleus
__________________________________________________________
______________________
DNA
__________________________________________________________
_____________________
endoplasmic reticulum
__________________________________________________________
______
cell membrane
__________________________________________________________
________
catabolism
__________________________________________________________
___________________
anabolism
__________________________________________________________
_______________________
metabolism
__________________________________________________________
_____________________
Give the term that suits the meaning provided. Check your
answers with Study Section 3, page 45.
membrane surrounding the lungs
________________________________________________________
membrane surrounding the abdominal viscera
____________________________________________________
muscular wall separating the thoracic and abdominal cavities
_____________________________________
space between the lungs, containing the heart, windpipe, aorta
______________________________________
backbone
__________________________________________________________
_______________
pad of cartilage between each backbone and the next
________________________________________________
FYI: Here are common abnormalities of the spinal column.
161
162
CHAPTER 3
163
Suffixes
CHAPTER SECTIONS:
Introduction 72
Combining Forms 72
Suffixes and Terminology 74
A Closer Look 82
Practical Applications 88
Exercises 88
Answers to Exercises 96
Pronunciation of Terms 98
Review Sheet 100
CHAPTER GOALS
• Define new suffixes and review those presented in previous chapters.
• Gain practice in word analysis by using these suffixes with combining
forms to build and understand terms.
• Identify the functions of the different types of blood cells in the body.
164
165
Introduction
In this chapter you will encounter many of the most common suffixes in
the medical language. As you work through the entire book, these
suffixes will appear often. An additional group of suffixes is presented
in Chapter 6.
Additional combining forms are presented in this chapter to use in
making words with suffixes. Your mastery of this material and your
analysis of the words in the section on Suffixes and Terminology will
increase your medical language vocabulary.
Combining Forms
Use the following list of combining forms as you write the meanings of
terms starting on page 74.
166
COMBINING
FORM
abdomin/o
acr/o
acu/o
aden/o
adip/o
amni/o
angi/o
arteri/o
arthr/o
axill/o
bi/o
blephar/o
bronch/o
carcin/o
cardi/o
chem/o
chondr/o
chron/o
col/o
cyst/o
encephal/o
erythr/o
hem/o
hepat/o
hydr/o
inguin/o
isch/o
lapar/o
laryng/o
leuk/o
lymph/o
mamm/o
mast/o
morph/o
muc/o
my/o
myel/o
necr/o
nephr/o
neur/o
neutr/o
nucle/o
ophthalm/o
opi/o
oste/o
ot/o
path/o
MEANING
abdomen
extremities, top, extreme point
sharp, severe, sudden
gland
fat
amnion (sac surrounding the embryo in the uterus)
vessel
artery
joint
armpit
life
eyelid
bronchial tubes (two tubes, one right and one left, that branch from the
trachea to enter the lungs)
cancer
heart
drug, chemical
cartilage
time
colon (large intestine)
urinary bladder
brain
red
blood
liver
water, fluid
groin
to hold back
abdomen, abdominal wall
larynx
white
lymph
Clear fluid that bathes tissue spaces and is contained in lymph vessels and
nodes throughout the body.
breast
breast
shape, form
mucus
muscle
spinal cord; bone marrow
Context of usage indicates the meaning intended.
death (of cells or whole body)
kidney
nerve
neutrophil (a white blood cell)
nucleus
eye
opium
bone
ear
disease
167
COMBINING
FORM
peritone/o
phag/o
phleb/o
plas/o
pleur/o
pneumon/o
pulmon/o
radi/o
rect/o
ren/o
rhin/o
sarc/o
splen/o
staphyl/o
strept/o
thorac/o
thromb/o
tonsill/o
trache/o
ven/o
MEANING
peritoneum
to eat, swallow
vein
formation, development
pleura (membrane surrounding lungs and adjacent to chest wall)
lungs
lungs
x-rays
rectum
kidney
nose
flesh
spleen
clusters
twisted chains
chest
clot
tonsils
trachea (windpipe)
vein
Encephal/o, Cerebr/o, Cephal/o, Crani/o, and
Psych/o
Don't confuse the meanings of these combining forms!
Encephal/o = brain
Cerebr/o = cerebrum (largest part of the brain)
Cephal/o = head
Crani/o = skull
Psych/o = mind
Larynx and Other Parts of the Body Ending
in x
coccyx = tailbone
larynx = voice box
pharynx = throat
phalanx = finger or toe
168
To make combining forms for parts of the body that end in x,
substitute g for x:
coccyg/o
laryng/o
pharyng/o
phalang/o
Suffixes and Terminology
Noun Suffixes
After the meaning of each suffix, terminology illustrates the use of that
suffix. Recall the basic rule for building a medical term: Use a
combining vowel, such as o, to connect the root to the suffix. However,
drop the combining vowel if the suffix begins with a vowel—for
example, gastr/itis, not “gastr/o/itis.”
Beginning on page 82, more detail is given about specific terms. This
section, called A Closer Look, will give you a fuller understanding of
the terminology.
169
SUFFIX
-algia
MEANING
pain
-cele
hernia
(see A
Closer
Look:
Hernia,
page 82)
puncture to
remove fluid
-centesis
-coccus
(singular)
-cocci
(plural)
berry-shaped
bacterium
(plural:
bacteria)
-cyte
cell
-dynia
pain
-ectomy
excision,
removal,
resection
blood
condition
-emia
-genesis
condition of
producing,
forming
TERMINOLOGY
MEANING
arthralgia ______________________________________
otalgia ______________________________________
neuralgia ______________________________________
myalgia ______________________________________
Fibromyalgia is a common chronic disorder that involves
widespread pain in muscles and fibrous tissues around joints.
rectocele ______________________________________
cystocele ______________________________________
thoracentesis ______________________________________
Notice that this term is shortened from thoracocentesis.
amniocentesis ______________________________________
The amnion is the sac (membrane) surrounding the embryo
(fetus after the 8th week) in the uterus. Fluid accumulates
within the amnion and may be withdrawn for analysis between
the 12th and 18th weeks of pregnancy. See Figure 3-1.
abdominocentesis
______________________________________
This procedure is more commonly known as abdominal
paracentesis (para- means beside or near). A tube is placed
through an incision in the abdomen and fluid is removed from
the peritoneal cavity (beside the abdominal organs).
streptococcus ______________________________________
staphylococci ______________________________________
(stah-fih-lo-KOK-si)
Microbiologists often refer to bacteria in clusters as “staph.”
See A Closer Look: Streptococci, Staphylococci, and Other
Bacteria, page 83.
erythrocyte ______________________________________
See A Closer Look: Blood Cells, page 84.
leukocyte ______________________________________
thrombocyte ______________________________________
pleurodynia ______________________________________
Pain in the chest wall muscles that is aggravated by breathing.
laryngectomy ______________________________________
mastectomy ______________________________________
anemia ______________________________________
ischemia ______________________________________
Literally, to hold back (isch/o) blood (-emia) from a part of the
body or tissue. Because of a decrease in blood supply (blood clot
in a vessel or narrowing and closing off of a vessel), tissue
becomes ischemic and can even die if it is deprived of oxygen
long enough.
HINT: You may be familiar with a TIA (transient ischemic
a ack), which is a “mini-stroke” that occurs when blood is
held back from tissue in the brain.
carcinogenesis ______________________________________
pathogenesis ______________________________________
angiogenesis ______________________________________
170
SUFFIX
-gram
-graph
-graphy
-itis
-logy
-lysis
-malacia
-megaly
-oma
-opsy
-osis
-pathy
MEANING
record
TERMINOLOGY
MEANING
electroencephalogram
______________________________________
mammogram ______________________________________
instrument
electroencephalograph
for recording ______________________________________
process of
electroencephalography
recording
______________________________________
angiography ______________________________________
inflammation
bronchitis ______________________________________
myelitis ______________________________________
Myel/o means spinal cord in this term.
tonsillitis ______________________________________
Tonsils (notice the spelling with one le er, whereas the
combining form has a double le er) are lymphatic tissue in the
back of the throat. See Figure 3-2.
thrombophlebitis
______________________________________
Also called phlebitis.
study of
ophthalmology
______________________________________
morphology ______________________________________
breakdown,
hemolysis ______________________________________
destruction,
Normal breakdown of red blood cells. Excessive destruction of
separation
red blood cells can lead to a type of anemia called hemolytic
anemia.
softening
osteomalacia ______________________________________
chondromalacia
______________________________________
enlargement
acromegaly ______________________________________
See A Closer Look: Acromegaly, page 86.
splenomegaly
_______________________________________
tumor, mass,
myoma _______________________________________
collection of
A benign tumor.
fluid
myosarcoma _______________________________________
A malignant tumor. Muscle is a type of flesh (sarc/o) tissue.
multiple myeloma
_______________________________________
Myel/o means bone marrow in this term. This malignant tumor
occurs in bone marrow tissue throughout the body.
hematoma _______________________________________
to view
biopsy _______________________________________
necropsy _______________________________________
This term is used in veterinary medicine. An autopsy is a
necropsy performed on humans.
condition,
necrosis _______________________________________
usually
hydronephrosis
abnormal
_______________________________________
leukocytosis _______________________________________
disease
cardiomyopathy
condition
_______________________________________
Primary disease of the heart muscle in the absence of a known
underlying etiology (cause).
171
SUFFIX
-penia
-phobia
-plasia
-plasty
-ptosis
-rrhea
-sclerosis
-scope
-scopy
-stasis
-stomy
MEANING
deficiency
TERMINOLOGY
MEANING
erythropenia _______________________________________
neutropenia _______________________________________
In this term, neutr/o indicates neutrophil (a type of white blood
cell).
thrombocytopenia
_______________________________________
fear
acrophobia _______________________________________
Fear of heights. Acr/o means extremities, in the sense of extreme
or far points. HINT: Think of acrobats who perform highwire acts.
agoraphobia _______________________________________
Agora means marketplace. This is an anxiety disorder marked
by fear of being outside of home alone, being in open or enclosed
places, or using public transportation.
development,
achondroplasia
formation,
_______________________________________
growth
This is an inherited disorder or can be the result of a mutation
(change) in a specific gene. Bones of the arms and legs do not
grow to normal size because of a defect in cartilage and bone
formation. Dwarfism results, marked by short limbs but
normal-sized head and trunk and normal intelligence. See
Figure 3-3.
surgical
angioplasty _______________________________________
repair
An interventional cardiologist opens a narrowed blood vessel
(artery) using a balloon that is inflated after insertion into the
vessel. Stents, or slo ed tubes, are then put in place to keep the
artery open.
drooping,
blepharoptosis _________________________________
falling,
Physicians use ptosis (TO-sis) alone to indicate drooping of
prolapse
the upper eyelids or the breasts. See Figure 3-4.
flow,
rhinorrhea ________________________________
discharge
hardening
arteriosclerosis _________________________________
In atherosclerosis (a form of arteriosclerosis), deposits of fat
(ather/o means fa y material) collect in an artery.
instrument
laparoscope _________________________________
for visual
examination
process of
laparoscopy _________________________________
visual
See Figure 3-5B below and A Closer Look: Laparoscopy,
examination
page 86.
(with an
endoscope)
controlling,
metastasis _________________________________
stopping
Meta- means beyond. A metastasis is the spread of a malignant
tumor beyond its original site to a secondary organ or location.
hemostasis _________________________________
Blood flow is stopped naturally by clo ing or artificially by
compression or suturing of a wound. A hemostat is a surgical
clamp used in operating rooms to stop blood flow.
opening to
colostomy _________________________________
form a
tracheostomy _________________________________
mouth
(stoma)
172
SUFFIX
-therapy
-tomy
-trophy
MEANING
treatment
TERMINOLOGY
MEANING
hydrotherapy _________________________________
chemotherapy _________________________________
radiotherapy _________________________________
High-energy radiation is used to treat, not diagnose, illness.
incision,
laparotomy _________________________________
cu ing into
Also referred to as a “lap,” this procedure is creation of a large
incision into the peritoneal cavity, often performed on an
exploratory basis. Don't confuse laparotomy with laparoscopy.
See Figure 3-5.
phlebotomy _________________________________
tracheotomy _________________________________
See A Closer Look: Tracheotomy, page 87.
development,
hypertrophy _________________________________
nourishment
(hy-PER-tro-fe) Cells increase in size, not number. Muscles of
weight lifters often hypertrophy.
atrophy _________________________________
Cells decrease in size. Muscles atrophy when immobilized in a
cast and not in use.
173
FIGURE 3-1 Amniocentesis. Under ultrasound guidance
(imaging based on high-frequency sound waves), the physician
inserts a needle through the uterine wall and amnion, into the
amniotic cavity. Amniotic fluid, containing fetal cells, is withdrawn
and grown (cultured) for microscopic analysis. A karyotype is
made to study chromosomes. Fluid is examined for chemicals
that indicate fetal defects.
174
FIGURE 3-2 Tonsillitis. This shows streptococcal tonsillitis with
intense erythema (redness) of the tonsils (see arrows) and a
creamy-yellow exudate (pus containing leukocytes and bacteria).
Normally, tonsils contain lymphocytes that fight bacteria. When
they become infected and inflamed, tonsillectomy may be
necessary.
FIGURE 3-3 Achondroplasia. A boy with achondroplasia. His
abnormalities include short stature with normal length of the
trunk, short limbs and fingers, bowed legs, prominent forehead,
and depressed nasal bridge. (Courtesy A.E. Chudley, MD, Section of
Genetics and Metabolism, Department of Pediatrics and Child Health,
Children's Hospital, Winnipeg, Manitoba, Canada.)
175
FIGURE 3-4 Ptosis of the upper eyelid (blepharoptosis).
This condition may be congenital (appear at birth), can occur with
aging, or may be associated with stroke (cerebrovascular
accident), cranial nerve damage, and other neurologic disorders.
The eyelid droops because of muscle weakness.
FIGURE 3-5 A. Laparotomy. This large incision was closed
with surgical staples. B. Laparoscopy. The abdomen is
examined making small incisions and using a laparoscope. This
procedure is often used to examine and remove organs such as
the appendix and gallbladder.
The following are shorter noun suffixes that usually are a ached to
roots in words.
176
SUFFIX MEANING
-er
one who
-ia
-ist
-oid
-ole
-ule
-um, ium
-us
-y
TERMINOLOGY
MEANING
radiographer _________________________________
A technologist who assists in the making of diagnostic x-ray
pictures.
condition
leukemia _________________________________
This is a group of cancers that begins in bone marrow and results in
high numbers of abnormal, immature white blood cells.
pneumonia _________________________________
specialist
nephrologist _________________________________
resembling,
opioid _________________________________
derived from
adenoids _________________________________
See A Closer Look: Adenoids, page 87.
li le, small
arteriole _________________________________
See Figure 3-6.
li le, small
venule _________________________________
See Figure 3-6.
structure,
pericardium _________________________________
tissue
This membrane surrounds the heart.
structure,
mucus _________________________________
substance
esophagus _________________________________
Eso- means within or inward.
condition,
nephropathy _________________________________
process
(neh-FROP-ah-the)
FIGURE 3-6 Relationship of blood vessels. An artery carries
blood rich in oxygen from the heart to the organs of the body. In
the organs, the artery narrows to form arterioles (small arteries)
that branch into capillaries (the smallest blood vessels). Through
the thin walls of capillaries, oxygen leaves the blood and enters
cells. Thus, the capillaries branching into venules (small veins)
carry blood low in oxygen. Venules lead to a vein that brings
oxygen-poor blood back to the heart.
Adjective Suffixes
No simple rule will explain which suffix meaning “pertaining to” is
used with a specific combining form. Concentrate on identifying the
suffix in each term; then write the meaning of the term. For a list of
suffixes meaning “pertaining to,” see the Glossary of Word Parts
beginning on page 967.
177
SUFFIX MEANING
-ac, -iac pertaining to
-al
pertaining to
-ar
-ary
pertaining to
pertaining to
-eal
-genic
pertaining to
pertaining to
producing,
produced by
or in
-ic, -ical pertaining to
-ose
-ous
-tic
TERMINOLOGY
MEANING
cardiac _________________________________
peritoneal _________________________________
inguinal _________________________________
myocardial _________________________________
A myocardial infarction (MI) is a heart a ack. An infarction is an
area of dead tissue (necrosis) resulting from ischemia (lack of blood
supply to that tissue).pleural
_________________________________
tonsillar _________________________________
pulmonary _________________________________
axillary _________________________________
Axillary lymph nodes are found in the armpit and are important in
breast cancer.
laryngeal _________________________________
carcinogenic _________________________________
osteogenic _________________________________
An osteogenic sarcoma is a malignant tumor produced in bone.
chronic _________________________________
Acute is the opposite of chronic. It describes a disease that is of rapid
onset and has severe symptoms and brief duration.
pathologic _________________________________
pertaining to, adipose _________________________________
full of
pertaining to
mucous membrane _________________________________
Mucous (an adjective) membranes produce the sticky secretion
called mucus (a noun).
pertaining to necrotic _________________________________
Formation of Plurals
Words ending in -us commonly form their plural by dropping -us and
adding -i. Other examples of -us plural formation follow:
nucleus → nuclei
bronchus → bronchi
thrombus → thrombi
See Appendix I at the end of the book for additional information
about plural formation.
Anemia
While anemia literally means “no blood,” it is actually a condition
marked by reduction in the number of erythrocytes or in the amount of
hemoglobin in blood. Examples of types of anemias are:
178
• iron deficiency anemia (iron is needed to make hemoglobin)
• sickle cell anemia (erythrocytes assume an abnormal sickle shape
and clog blood vessels)
• aplastic anemia (erythrocytes, leukocytes, and thrombocytes are
not formed in bone marrow)
Splenomegaly
The spleen is an organ in left upper quadrant (LUQ) of the abdomen
(below the diaphragm and to the side of the stomach). Composed of
lymph tissue and blood vessels, it disposes of dying red blood cells and
contains white blood cells to fight disease. Splenomegaly occurs with
development of high blood pressure in hepatic veins and hemolytic
blood diseases (anemias involving excessive destruction or lysis of red
blood cells). If the spleen is removed (splenectomy), other organs carry
out its functions.
Common Surgical Repair Procedures
Popular procedures include:
abdominoplasty—abdomen
mammoplasty—breast
blepharoplasty—eyelid
rhinoplasty—nose
Opioid
An opioid is a drug derived from the opium poppy plant. Opioids, also
known as narcotics (narc/o means stupor or sleep), include heroin,
fentanyl, oxycodone (OxyContin), hydrocodone (Vicodin), codeine, and
morphine. These drugs act on brain receptors to alleviate pain. Misuse
of opioids increases the risk of addiction, overdose, and death. A
medication called buprenorphine treats opioid addiction. While
reducing acute and chronic pain, it minimizes withdrawal symptoms.
Narcan (naloxone) is a medication to counter the effects of lifethreatening opioid overdose.
Axillary Lymph Nodes and Breast Cancer
179
Breast cancer cells often spread to axillary lymph nodes. When this
occurs, the tumor found in the axillary lymph nodes is a breast cancer
metastasis. The first lymph node to which cancer is most likely to
spread is called the sentinel axillary lymph node. It is removed during
mastectomy or lumpectomy and biopsied to determine if the cancer has
spread beyond the breast (metastasized).
180
A Closer Look
Hernia
A hernia is protrusion of an organ or the muscular wall of an organ
through the cavity that normally contains it. A hiatal hernia occurs
when the stomach protrudes upward into the mediastinum through the
esophageal opening in the diaphragm (Figure 3-7). An inguinal hernia
occurs when part of the intestine protrudes downward into the groin
region and commonly into the scrotal sac in the male. A cystocele
occurs when part of the urinary bladder herniates through the vaginal
wall as a result of weakness of the pelvic muscles (Figure 3-8). A
rectocele is the protrusion of a portion of the rectum toward the vagina
(Figure 3-8). An omphalocele (omphal/o = umbilicus, navel) is a
herniation of the intestines through a weakness in the abdominal wall
around the navel occurring in infants at birth. See Figure 3-9.
FIGURE 3-7 Hiatal hernia. Consequences of a hiatal hernia
include reflux of gastric contents and acid into the esophagus,
producing esophagitis. This inflammation causes chest pain
commonly mistaken for a heart attack and known as “heartburn.”
181
FIGURE 3-8 Hernias: cystocele and rectocele. Arrows point
to the areas of herniation. In a cystocele, a portion of the urinary
bladder herniates posteriorly toward the vagina. In a rectocele, a
portion of the rectum herniates anteriorly toward the vagina.
FIGURE 3-9 Omphalocele. This baby was born with a large
omphalocele containing intra-abdominal viscera. His parents
were advised to wait and have surgery performed when his
abdominal muscles had grown large enough to close over the
hernia. Surgery was performed at 7.5 months to permanently
repair the hernia.
Streptococci, Staphylococci, and Other Bacteria
Streptococcus, a berry-shaped bacterium, grows in twisted chains. One
group of streptococci causes such conditions as “strep throat,”
tonsillitis, rheumatic fever, and certain kidney ailments, whereas
another group causes infections in teeth, within the sinuses (cavities) of
the nose and face, and in the valves of the heart.
Staphylococci, other berry-shaped bacteria, grow in small clusters
like grapes. Staphylococcal lesions may be external (skin abscesses,
boils, styes) or internal (abscesses in bone and kidney). An abscess is a
collection of pus, white blood cells, and protein that is present at the site
of infection. MRSA (methicillin-resistant Staphylococcus aureus) is a
182
serious staphylococcal condition that is difficult to treat with antibiotics.
It can become an antibiotic resistant infection when the MRSA bacteria
develop the ability to resist or defeat the drugs designed to kill them.
Examples of diplococci (berry-shaped bacteria organized in pairs;
dipl/o = two) are pneumococci (pneum/o = lungs) and gonococci (gon/o
= seed). Pneumococci cause bacterial pneumonia, and gonococci invade
the reproductive organs, causing gonorrhea (a sexually transmi ed
infection). Figure 3-10 illustrates the different growth pa erns of
streptococci, staphylococci, and diplococci.
FIGURE 3-10 Types of coccal bacteria. Notice the berry or
rounded shape of each bacterium. Streptococci and
staphylococci are gram-positive bacteria, meaning that they
retain the light purple color of the stain used in Gram's method
(named for Hans C.J. Gram, Danish physician, 1853-1938.)
Gram-negative bacteria (such as diplococci) have the pink
color of the counterstain (safranin) used in Gram's method.
Another group of bacteria are not in a rounded shape, but in the
shape of rods. An example is clostridium difficile bacteria. C. difficile
infection, which causes inflammation of the colon and severe diarrheal
disease, is common in patients who take antibiotics for long periods of
time. This is because C. difficile bacteria can become resistant to those
antibiotics. In order to restore normal bacteria in the digestive tract, a
fecal transplant (bacteriotherapy) may be necessary. This is the transfer
of stool containing normal bacteria from a healthy donor into the colon
of the patient with chronic C. difficile infection.
Blood Cells
Refer to Figure 3-11 as you read the following to note the differences
among the three different types of cells in the blood.
183
FIGURE 3-11 Types of blood cells. HINT: Here's an easy way
to remember the names of the five leukocytes:
Never (neutrophil)
Let (lymphocyte)
Monkeys (monocyte)
Eat (eosinophil)
Bananas (basophil)
ERYTHROCYTES, or red blood cells, are the first type. These cells
are made in the bone marrow (soft tissue in the center of certain bones).
They carry oxygen from the lungs through the blood to all body cells.
Body cells use oxygen to burn food and release energy (catabolism).
Hemoglobin (globin = protein), an important protein in erythrocytes,
carries the oxygen through the bloodstream.
184
LEUKOCYTES, or white blood cells, are the second type. There are
five different kinds of leukocytes: three granulocytes, or
polymorphonuclear cells, and two mononuclear cells.
• Granulocytes contain dark-staining granules in
their cytoplasm and have a multilobed nucleus.
They are formed in the bone marrow. There are
three types:
1. Eosinophils (granules stain red [eosin/o = rosy]
with acidic stain) are increased in number in
allergic conditions such as asthma. About 3% of
leukocytes are eosinophils.
2. Basophils (granules stain blue with basic [bas/o
= basic] stain). The function of basophils is not
clear, but the number of these cells increases in
the healing phase of inflammation. Less than 1%
of leukocytes are basophils.
3. Neutrophils (granules stain a pale purple with
neutral stain) are the most important diseasefighting cells and the most numerous. About
50% to 60% of all leukocytes are neutrophils.
They are phagocytes (phag/o = eating,
swallowing)—engulfing and digesting bacteria
like circulating “Pac-Men.” Neutrophils are
referred to as “polys,” or polymorphonuclear
leukocytes (poly = many, morph/o = shape),
because of their multilobed nucleus.
• Mononuclear cells have one large nucleus
(mononuclear) and only a few granules in their
cytoplasm. They are produced in bone marrow, as
well as in lymph nodes and the spleen. There are
two types of mononuclear leukocytes (see Figure 311):
185
4. Lymphocytes (lymph cells) fight disease by
producing antibodies, thereby destroying
foreign cells. They also may a ach directly to
foreign cells and destroy them. Two types of
lymphocytes are T cells and B cells. About 32%
of white blood cells are lymphocytes. In AIDS
(acquired immunodeficiency syndrome),
patients have a serious depletion of T
lymphocytes (T cells).
5. Monocytes (containing one [mon/o = one] very
large nucleus) engulf and destroy cellular debris
after neutrophils have a acked foreign cells.
Monocytes leave the bloodstream and enter
tissues (such as lung and liver) to become
macrophages, which are large phagocytes.
Monocytes make up about 4% of all leukocytes.
See Table 3-1 to review the five types of leukocytes. Each type fights
infection in a specific manner. This is similar to the five branches of the
armed forces (Navy, Army, Air Force, Marines, and Coast Guard), each
of which is equipped with specialized skills and procedures.
TABLE 3-1
FIVE TYPES OF LEUKOCYTES (WHITE BLOOD CELLS)
THROMBOCYTES or PLATELETS (clo ing cells) are the third type
of blood cell. These are actually tiny fragments of cells formed in the
bone marrow and are necessary for blood clo ing.
Acromegaly
Acromegaly is an endocrine disorder. It occurs when the pituitary
gland, a ached to the base of the brain, produces an excessive amount
of growth hormone after the completion of puberty. The excess growth
hormone most often results from a benign tumor of the pituitary gland.
A person with acromegaly typically is of normal height because the
186
p
g y yp
y
g
long bones have stopped growth after puberty, but bones and soft tissue
in the hands, feet, and face grow abnormally (Figure 3-12). Abraham
Lincoln was believed to have features of acromegaly. See Chapter 18,
Endocrine System, page 699. Gigantism is the result of overproduction
of pituitary growth hormone beginning in childhood.
FIGURE 3-12 Acromegaly. Notice the changes in facial
features (widening of the nose and jaw) and enlargement of the
hands of my grandmother, Bessie Brandwein.
Laparoscopy
Laparoscopy (a form of minimally invasive surgery) is visual
examination of the abdominal cavity using a laparoscope. A surgeon
inserts the laparoscope, a lighted telescopic instrument, through an
incision in the abdomen near the navel. Then, gas (carbon dioxide) is
infused into the peritoneal cavity, to separate and prevent injury to
abdominal structures during surgery. Surgeons use laparoscopy to
examine abdominal viscera for evidence of disease (performing
biopsies) or for procedures such as removal of the appendix,
gallbladder, adrenal gland, spleen, or ovary; resection of the colon; and
repair of hernias. In tubal ligation, the laparoscope contains an
instrument to clip and collapse the fallopian tubes, which prevents
sperm cells from reaching eggs that leave the ovary (Figure 3-13).
187
FIGURE 3-13 Laparoscopy for tubal ligation (interruption of
the continuity of the fallopian tubes) as a means of preventing
future pregnancy. The vaginal speculum keeps the vaginal
cavity open. The uterine cannula is a tube placed into the uterus
to manipulate the uterus during the procedure. Forceps, placed
through the laparoscope, grasp or move tissue.
Tracheotomy
A tracheotomy is an incision into the trachea typically done to open it
below a blockage. Tracheotomy may be performed to remove a foreign
body or to obtain a biopsy specimen (Figure 3-14A).
FIGURE 3-14 A, Tracheotomy. B, Tracheostomy.
A tracheostomy is an opening into the trachea through which an
indwelling tube is inserted. The tube is required to allow air to flow into
188
the lungs or to help remove secretions (mucus) from the bronchial
tubes. When a temporary tracheostomy is performed, extreme care is
used to insert the tracheostomy tube below the larynx so that the vocal
cords are not damaged (Figure 3-14B).
Adenoids
The adenoids are small masses of lymphatic tissue in the part of the
pharynx (throat) near the nose and nasal passages. The literal meaning,
“resembling glands,” is appropriate because they are neither endocrine
nor exocrine glands. Enlargement of adenoids may cause blockage of
the airway from the nose to the pharynx, and adenoidectomy may be
advised. The tonsils also are lymphatic tissue, and their location as well
as that of the adenoids is indicated in Figure 3-15.
FIGURE 3-15 Adenoids and tonsils. The adenoids and tonsils
are lymphatic tissue in the pharynx (throat).
Practical Applications
Procedures and Their Definitions
Choose the correct diagnostic or treatment procedure for each of the
numbered definitions. Answers are on page 97.
amniocentesis
189
angiography
angioplasty
colostomy
laparoscopy
laparotomy
mastectomy
paracentesis (abdominocentesis)
thoracentesis
tonsillectomy
1. removal of abdominal fluid (ascites) from the peritoneal space
_________________________________
2. large abdominal incision to remove an ovarian adenocarcinoma
_________________________________
3. removal of the breast
__________________________________________________________
4. a method used to determine the karyotype of a fetus
_________________________________
5. surgical procedure to remove pharyngeal lymphatic tissue
_________________________________
6. surgical procedure to open clogged coronary arteries
_________________________________
7. method of removing fluid from the chest (pleural effusion)
_________________________________
8. procedure to drain waste from the body after bowel resection
_________________________________
9. x-ray procedure used to examine blood vessels before surgery
_________________________________
10. minimally invasive surgery within the abdomen
_________________________________
190
Exercises
Remember to check your answers carefully with the Answers to
Exercises on pages 96 and 97.
A Give the meanings for the following suffixes.
1. -cele
_____________________________________________
____
2. -emia
_____________________________________________
____
3. -coccus
_____________________________________________
____
4. -gram
_____________________________________________
____
5. -cyte
_____________________________________________
____
6. -algia
_____________________________________________
____
7. -ectomy
_____________________________________________
____
8. -centesis
_____________________________________________
____
9. -genesis
_____________________________________________
____
191
10. -graph
_____________________________________________
____
11. -itis
_____________________________________________
____
12. -graphy
_____________________________________________
____
B Using the listed combining forms and your
knowledge of suffixes, build medical terms for the
definitions that follow.
amni/o
angi/o
arthr/o
bronch/o
carcin/o
cyst/o
isch/o
laryng/o
mast/o
my/o
myel/o
rhin/o
staphyl/o
strept/o
thorac/o
1. hernia of the urinary bladder
____________________________________________
192
2. pain of muscle
____________________________________________
3. process of producing cancer
____________________________________________
4. inflammation of the spinal cord
____________________________________________
5. berry-shaped bacteria in twisted chains
____________________________________________
6. surgical puncture to remove fluid from the chest
____________________________________________
7. removal of the breast
____________________________________________
8. inflammation of the tubes leading from the
windpipe to the lungs
____________________________________________
9. to hold back blood from cells
____________________________________________
10. process of recording (x-ray) blood vessels
____________________________________________
11. visual examination of joints
____________________________________________
12. berry-shaped bacteria in clusters
____________________________________________
13. resection of the voice box
____________________________________________
14. surgical procedure to remove fluid from the sac
around a fetus
____________________________________________
15. discharge from the nose
____________________________________________
193
C Match the listed terms, which describe blood cells,
with the meanings that follow.
basophil
eosinophil
erythrocyte
lymphocyte
monocyte
neutrophil
thrombocyte
1. granulocytic white blood cell (granules stain
purple) that destroys foreign cells by engulfing and
digesting them; also called a polymorphonuclear
leukocyte ____________________________
2. mononuclear white blood cell that destroys foreign
cells by making antibodies
_______________________________________________
________________
3. clo ing cell; also called a platelet
____________________________________________
4. leukocyte with reddish-staining granules and
numbers elevated in allergic reactions
_______________________________________________
__________________
5. red blood cell
____________________________________________
6. mononuclear white blood cell that engulfs and
digests cellular debris; contains one large nucleus
_______________________________________________
____________________
194
7. granulocytic white blood cell that increases during
the healing phase of inflammation
_______________________________________________
_____________________
D Give the meanings of the following suffixes.
1. -logy ____________________________
2. -lysis ____________________________
3. -pathy ___________________________
4. -penia ____________________________
5. -malacia ____________________________
6. -osis ____________________________
7. -phobia ____________________________
8. -megaly ____________________________
9. -oma ____________________________
10. -opsy ____________________________
11. -plasia ____________________________
12. -plasty ____________________________
13. -sclerosis ____________________________
14. -stasis ____________________________
E Using the combining forms below and your
knowledge of suffixes, build medical terms for the
following definitions.
acr/o
arteri/o
bi/o
blephar/o
cardi/o
chondr/o
195
hem/o
hydr/o
morph/o
my/o
myel/o
phleb/o
rhin/o
sarc/o
splen/o
1. enlargement of the spleen
_________________________________________
2. study of the shape (of cells)
_________________________________________
3. softening of cartilage
_________________________________________
4. abnormal condition of water (fluid) in the kidney
_________________________________________
5. disease condition of heart muscle
_________________________________________
6. hardening of arteries
_________________________________________
7. tumor (benign) of muscle
_________________________________________
8. flesh tumor (malignant) of muscle
_________________________________________
9. surgical repair of the nose
_________________________________________
10. tumor of bone marrow
_________________________________________
196
11. fear of heights
_________________________________________
12. view of living tissue under a microscope
_________________________________________
13. stoppage of the flow of blood (by mechanical or
natural means)
_________________________________________
14. inflammation of the eyelid
_________________________________________
15. incision of a vein
_________________________________________
F Give the plural formations of the following terms:
1. bacterium _______________________
2. metastasis _______________________
3. vertebra _______________________
4. streptococcus _______________________
5. nucleus _______________________
6. prognosis _______________________
G Match the following terms with their meanings.
achondroplasia
acromegaly
atrophy
chemotherapy
colostomy
hydrotherapy
hypertrophy
laparoscope
laparoscopy
197
metastasis
necrosis
osteomalacia
1. treatment using drugs
_____________________________________________
_
2. condition of death (of cells)
_____________________________________________
_
3. softening of bone
_____________________________________________
_
4. opening of the large intestine to the outside of the
body
_____________________________________________
_
5. no development; shrinkage of cells
_____________________________________________
_
6. beyond control; spread of a cancerous tumor to
another organ
_____________________________________________
_
7. instrument to visually examine the abdomen
_____________________________________________
_
8. enlargement of extremities; an endocrine disorder
that causes excess growth hormone to be produced
by the pituitary gland after puberty
_____________________________________________
_
198
9. condition of improper formation of cartilage in the
embryo that leads to short bones and dwarfism
_____________________________________________
_
10. process of viewing the peritoneal (abdominal)
cavity
_____________________________________________
_
11. treatment using water
_____________________________________________
_
12. excessive development of cells (increase in size of
individual cells)
_____________________________________________
_
H Give the meanings of the following suffixes.
1. -ia _______________________
2. -trophy _______________________
3. -stasis _______________________
4. -stomy _______________________
5. -tomy _______________________
6. -ole _______________________
7. -um _______________________
8. -ule _______________________
9. -y _______________________
10. -oid _______________________
11. -genic _______________________
12. -ptosis _______________________
199
I Using the lists of combining forms and suffixes
below, build medical terms for the following
definitions.
COMBINING FORMS
arteri/o
pleur/o
lapar/o
pneumon/o
mamm/o
radi/o
nephr/o
ven/o
SUFFIXES
-dynia
-ectomy
-gram
-ia
-ole
-pathy
-plasty
-scopy
-therapy
-tomy
-ule
1. incision of the abdomen
_____________________________________________
_
2. process of visual examination of the abdomen
_____________________________________________
_
3. a small artery
_____________________________________________
_
4. condition of the lungs
_____________________________________________
_
5. treatment using x-rays
_____________________________________________
_
6. record (x-ray film) of the breast
_____________________________________________
_
7. pain of the chest wall and the membranes
surrounding the lungs
_____________________________________________
_
8. a small vein
_____________________________________________
200
_
9. disease condition of the kidney
_____________________________________________
_
10. surgical repair of the breast
_____________________________________________
_
J Underline the suffix in the following terms, and give
the meaning of the entire term.
1. laryngeal
_____________________________________________
_
2. inguinal
_____________________________________________
_
3. chronic
_____________________________________________
_
4. pulmonary
_____________________________________________
_
5. adipose
_____________________________________________
_
6. peritoneal
_____________________________________________
_
7. axillary
_____________________________________________
_
201
8. necrotic
_____________________________________________
_
9. opioid
_____________________________________________
_
10. mucous
_____________________________________________
_
11. agoraphobia
_____________________________________________
_
12. esophagus
_____________________________________________
_
K Select from the listed terms relating to blood and
blood vessels to complete the sentences that follow.
anemia
angioplasty
arterioles
hematoma
hemolysis
hemostasis
ischemia
leukemia
leukocytosis
multiple myeloma
myocardial
neutropenia
202
thrombocytopenia
venules
1. Billy was diagnosed with excessively high numbers
of cancerous white blood cells, or
_________________. His doctor prescribed
chemotherapy and expected an excellent
prognosis.
2. Mr. Clark's angiogram showed that he had serious
atherosclerosis of one of the arteries supplying
blood to his heart. His doctor recommended that
________________ would be helpful to open up his
clogged artery by threading a catheter (tube)
through his artery and opening a balloon at the
end of the catheter to widen the artery.
3. Due to the shock of multiple foot strikes, longdistance runners can develop breakdown of red
blood cells called _____________________. This
condition, which leads to excessive loss of blood
cells is known as runner's _____________________.
4. Doctors refused to operate on Joe because of his
low platelet count, a condition called
______________________.
5. Blockage of an artery leading to Mr. Stein's brain
led to the holding back of blood flow to nerve
tissue in his brain. This condition, called
_____________________, could lead to necrosis of
tissue and a cerebrovascular accident.
6. Small arteries, or ______________________, were
broken under Ms. Bein's scalp when she was struck
on the head with a rock. She soon developed a
mass of blood, a/an
203
____________________________, under the skin in
that region of her head.
7. Sarah Jones had a staphylococcal infection, causing
elevation of her white blood cell count, known as
____________________________. She was treated
with antibiotics, and her blood count returned to
normal.
8. Within the body, the bone marrow (soft tissue
within bones) is the “factory” for making blood
cells. Mr. Sco developed
____________________________, a malignant
condition of the bone marrow cells in his hip,
upper arm, and thigh bones.
9. During operations, surgeons use clamps to close off
blood vessels and prevent blood loss. In this way,
they maintain ___________________ and avoid
blood transfusions.
10. Small vessels that carry blood toward the heart
from capillaries and tissues are
___________________________________.
11. Chemotherapy causes destruction of rapidly
dividing cancer cells as well as rapidly dividing
normal white blood cells. This deficiency of white
blood cells is a side effect of chemotherapy called
___________________________________.
12. An acute ____________________________
infarction is the medical term for a heart a ack.
L Complete the medical term for the following
definitions.
204
DEFINITION
1. membrane surrounding the heart
2. hardening of arteries
3. enlargement of the liver
4. new opening of the windpipe to the outside of the body
5. inflammation of the tonsils
6. surgical puncture to remove fluid from the abdomen
7. muscle pain
8. pertaining to the membranes surrounding the lungs
9. study of the eye
10. berry-shaped (spheroidal) bacteria in clusters
11. beyond control (spread of a cancerous tumor)
12. pertaining to the voice box
MEDICAL TERM
peri ______________________
arterio ______________________
hepato ______________________
tracheo ______________________
____________________ itis
abdomino ______________________
my ______________________
_____________________ al
___________________ logy
__________________ cocci
meta ______________________
____________________ eal
M Select from the meanings in Column II to match the
suffixes in Column I. Write each meaning in the
space provided.
COLUMN I
Suffixes: Conditions
1. -algia or -dynia ___________________________________
2. -cele ___________________________________
3. -megaly ___________________________________
4. -oma ___________________________________
5. -penia ___________________________________
6. -phobia ___________________________________
7. -plasia ___________________________________
8. -emia ___________________________________
9. -itis ___________________________________
10. -trophy ___________________________________
11. -stasis ___________________________________
12. -sclerosis ___________________________________
13. -lysis ___________________________________
14. -ptosis ___________________________________
15. -malacia ___________________________________
COLUMN II
Meanings
blood condition
controlling; stopping
deficiency
destruction; breakdown
development; nourishment
falling; drooping; prolapse
enlargement
fear
formation
hardening
hernia
inflammation
pain
softening
tumor; mass
N Select from the meanings in Column II to match the
suffixes in Column I. Write each meaning in the
space provided.
205
COLUMN I
Suffixes: Procedures
1. -centesis ___________________________________
2. -opsy ___________________________________
3. -ectomy ___________________________________
4. -tomy ___________________________________
5. -stomy ___________________________________
6. -therapy ___________________________________
7. -plasty ___________________________________
8. -scopy ___________________________________
9. -scope ___________________________________
10. -graphy ___________________________________
11. -gram ___________________________________
12. -graph ___________________________________
COLUMN II
Meanings
excision
incision
instrument to record
instrument to visually examine
new opening
process of recording
process of visual examination
record
puncture to remove fluid
surgical repair
to view
treatment
O Circle the correct term to complete the following
sentences.
1. Ms. Daley, who has nine children, visited her
general practitioner because she was experiencing
problems with urination. After examining her, the
doctor found that her bladder was protruding into
her vagina and told her she had a (rectocele,
cystocele, hiatal hernia).
2. Susan coughed constantly for a week. Her
physician told her that her chest x-ray examination
showed evidence of pneumonia. Her sputum
(material coughed up from the bronchial tubes)
was found to contain (ischemic, pleuritic,
pneumococcal) bacteria.
3. Mr. Manion went to see his family doctor because
he couldn't keep his left upper eyelid from sagging.
His doctor told him that he had a neurologic
problem called Horner syndrome, characterized by
(necrosis, hydronephrosis, ptosis) of his eyelid.
4. Jill broke her left arm in a fall while mountain
biking. After 6 weeks in a cast to treat the fracture,
her left arm was noticeably smaller and weaker
than her right arm—the muscles had (atrophied,
206
g
p
hypertrophied, metastasized). Her physician
recommended physical therapy to strengthen the
affected arm.
5. Ms. Brody was diagnosed with breast cancer. The
first phase of her treatment included a
(nephrectomy, mastectomy, pulmonary resection)
to remove her breast and the tumor. After the
surgery, her doctors recommended
(chemotherapy, radiotherapy, hydrotherapy)
using drugs such as doxorubicin (Adriamycin) and
paclitaxel (Taxol).
6. At age 29, Kevin's facial features became coarser
and his hands and tongue enlarged. After a head
CT (computed tomography) scan, doctors
diagnosed the cause of these changes as
(hyperglycemia, hyperthyroidism, acromegaly), a
slowly progressive endocrine condition involving
the pituitary gland.
7. Each winter during “cold and flu season,” Daisy
developed (chondromalacia, bronchitis,
cardiomyopathy). Her doctor prescribed
antibiotics and respiratory therapy to help her
recover.
8. After undergoing (arthroscopy, laparotomy,
radiotherapy) on his knee, Alan noticed swelling
and inflammation near the small incisions. Dr.
Nicholas assured him that this was a common side
effect of the procedure that would resolve
spontaneously.
9. Under the microscope, Dr. Vance could see grapelike clusters of bacteria called (eosinophils,
streptococci, staphylococci). She made the
207
diagnosis of (staphylococcemia, eosinophilia,
streptococcemia), and the patient was started on
antibiotic therapy.
10. David enjoyed weight lifting, but he recently
noticed a bulge in his right groin region. He visited
his doctor, who made the diagnosis of (hiatal
hernia, rectocele, inguinal hernia) and
recommended surgical repair.
208
Answers to Exercises
A
1. hernia
2. blood condition
3. berry-shaped bacterium
4. record
5. cell
6. pain
7. removal, excision, resection
8. puncture to remove fluid
9. process of producing, forming
10. instrument to record
11. inflammation
12. process of recording
B
1. cystocele
2. myalgia (“myodynia” is not used)
3. carcinogenesis
4. myelitis
5. streptococci (bacteria is a plural term)
6. thoracentesis or thoracocentesis
7. mastectomy
209
8. bronchitis
9. ischemia
10. angiography
11. arthroscopy
12. staphylococci
13. laryngectomy
14. amniocentesis
15. rhinorrhea
C
1. neutrophil
2. lymphocyte
3. thrombocyte
4. eosinophil
5. erythrocyte
6. monocyte
7. basophil
D
1. process of study
2. breakdown, separation, destruction
3. process of disease
4. deficiency, less than normal
5. softening
6. condition, abnormal condition
210
7. fear of
8. enlargement
9. tumor, mass
10. process of viewing
11. condition of formation, growth
12. surgical repair
13. hardening, to harden
14. to stop, control
E
1. splenomegaly
2. morphology
3. chondromalacia
4. hydronephrosis
5. cardiomyopathy
6. arteriosclerosis
7. myoma
8. myosarcoma
9. rhinoplasty
10. myeloma (called multiple myeloma)
11. acrophobia
12. biopsy
13. hemostasis
14. blepharitis
211
15. phlebotomy
F
1. bacteria
2. metastases
3. vertebrae
4. streptococci
5. nuclei
6. prognoses
G
1. chemotherapy
2. necrosis
3. osteomalacia
4. colostomy
5. atrophy
6. metastasis
7. laparoscope
8. acromegaly
9. achondroplasia
10. laparoscopy
11. hydrotherapy
12. hypertrophy
H
212
1. condition
2. development, nourishment
3. to stop, control
4. new opening
5. incision, cut into
6. small, li le
7. structure
8. small, li le
9. condition, process
10. resembling
11. pertaining to producing, produced by or in
12. falling, drooping, prolapse
I
1. laparotomy
2. laparoscopy
3. arteriole
4. pneumonia (this condition is actually pneumonitis)
5. radiotherapy
6. mammogram
7. pleurodynia
8. venule
9. nephropathy
10. mammoplasty
213
J
1. laryngeal—pertaining to the voice box
2. inguinal—pertaining to the groin
3. chronic—pertaining to time (over a long period of
time); the opposite of chronic is acute
4. pulmonary—pertaining to the lung
5. adipose—pertaining to (or full of) fat
6. peritoneal—pertaining to the peritoneum (membrane
around the abdominal organs)
7. axillary—pertaining to the armpit, under arm
8. necrotic—pertaining to death
9. opioid—substance derived from opium
10. mucous—pertaining to mucus
11. agoraphobia—fear of open spaces and being away
from home alone (agora means marketplace)
12. esophagus—tube leading from the throat to the
stomach
K
1. leukemia
2. angioplasty
3. hemolysis; anemia
4. thrombocytopenia
5. ischemia
6. arterioles; hematoma
214
7. leukocytosis
8. multiple myeloma
9. hemostasis
10. venules
11. neutropenia
12. myocardial
L
1. pericardium
2. arteriosclerosis
3. hepatomegaly
4. tracheostomy
5. tonsillitis
6. abdominocentesis (this procedure also is known as
paracentesis)
7. myalgia
8. pleural
9. ophthalmology
10. staphylococci
11. metastasis
12. laryngeal
M
1. pain
2. hernia
215
3. enlargement
4. tumor; mass
5. deficiency
6. fear
7. formation
8. blood condition
9. inflammation
10. development; nourishment
11. controlling; stopping
12. hardening
13. destruction; breakdown
14. falling; drooping; prolapse
15. softening
N
1. puncture to remove fluid
2. to view
3. excision
4. incision
5. new opening
6. treatment
7. surgical repair
8. process of visual examination
9. instrument to visually examine
216
10. process of recording
11. record
12. instrument to record
O
1. cystocele
2. pneumococcal
3. ptosis
4. atrophied
5. mastectomy; chemotherapy
6. acromegaly
7. bronchitis
8. arthroscopy
9. staphylococci; staphylococcemia
10. inguinal hernia
Answers to Practical Applications
1. paracentesis (abdominocentesis)
2. laparotomy
3. mastectomy
4. amniocentesis
5. tonsillectomy
6. angioplasty
7. thoracentesis
8. colostomy
217
9. angiography
10. laparoscopy
Pronunciation of Terms
The terms you have learned in this chapter are presented here with
their pronunciations. The CAPITAL le ers indicate the accented
syllable.
The meanings for all the terms are in the Mini-Dictionary beginning
on page 897. You can also hear each term pronounced on the Evolve
website (h p://evolve.elsevier.com/Chabner/language/).
218
TERM
abdominocentesis
achondroplasia
acromegaly
acrophobia
acute
adenoids
adipose
agoraphobia
amniocentesis
anemia
angiogenesis
angiography
angioplasty
arteriole
arteriosclerosis
arthralgia
atrophy
axillary
basophil
biopsy
blepharoptosis
bronchitis
carcinogenesis
carcinogenic
cardiac
cardiomyopathy
chemotherapy
chondromalacia
chronic
colostomy
cystocele
electrocephalograph
electroencephalogram
electroencephalography
eosinophil
erythrocyte
erythropenia
esophagus
hematoma
hemolysis
hemostasis
hydronephrosis
hydrotherapy
hypertrophy
inguinal
ischemia
laparoscope
laparoscopy
laparotomy
laryngeal
laryngectomy
leukemia
PRONUNCIATION
ab-dom-in-o-sen-TE-sis
a-kon-dro-PLAY-ze-ah
ak-ro-MEG-ah-le
ak-ro-FO-be-ah
uh-KYOOT
AH-deh-noydz
AH-dih-pohz
ah-gor-ah-FO-be-ah
am-ne-o-sen-TE-sis
ah-NE-me-ah
an-je-o-JEN-ih-sis
an-je-OG-rah-fe
AN-je-o-plas-te
ar-TE-re-ole
ar-te-re-o-skleh-RO-sis
ar-THRAL-jah
AT-ro-fe
AK-sil-ar-e
BA-so-fil
BI-op-se
bleh-fah-rop-TO-sis
brong-KI-tis
kar-sih-no-JEN-eh-sis
kar-sih-no-JEN-ik
KAR-de-ak
kar-de-o-mi-OP-ah-the
ke-mo-THER-ah-pe
kon-dro-mah-LA-shah
KRON-ik
ko-LOS-to-me
SIS-to-seel
eh-lek-tro-en-SEF-ah-lo-graf
eh-lek-tro-en-SEF-ah-lo-gram
eh-lek-tro-en-sef-ah-LOG-rah-fe
e-o-SIH-no-fil
eh-RITH-ro-site
eh-rith-ro-PE-ne-a
eh-SOF-ah-gus
he-mah-TO-mah
he-MOL-ih-sis
he-mo-STA-sis
hi-dro-neh-FRO-sis
hi-dro-THER-ah-pe
hi-PER-tro-fe
IN-gwih-nal
is-KE-me-ah
LAP-ah-ro-skope
lap-ah-ROS-ko-pe
lap-ah-ROT-o-me
lah-rin-JE-al
lah-rin-JEK-to-me
lu-KE-me-ah
219
TERM
leukocyte
leukocytosis
lymphocyte
mammogram
mastectomy
metastasis
monocyte
morphology
mucous membrane
mucus
myalgia
myelitis
myeloma
myoma
myocardial
myosarcoma
necropsy
necrosis
necrotic
nephrologist
nephropathy
neuralgia
neutropenia
neutrophil
ophthalmology
opioid
osteogenic
osteomalacia
otalgia
paracentesis
pathogenesis
pathologic
pericardium
peritoneal
phlebotomy
platelet
pleural
pleurodynia
pneumonia
polymorphonuclear leukocyte
ptosis
pulmonary
radiographer
radiotherapy
rectocele
rhinorrhea
splenomegaly
staphylococci
streptococcus
thoracentesis
thrombocyte
thrombocytopenia
PRONUNCIATION
LU-ko-site
lu-ko-si-TO-sis
LIM-fo-site
MAM-o-gram
mas-TEK-to-me
meh-TAS-tah-sis
MON-o-site
mor-FOL-o-je
MU-cus MEM-brayn
MU-cus
mi-AL-jah
mi-eh-LI-tis
mi-eh-LO-mah
mi-O-mah
mi-o-KAR-de-al
mi-o-sar-KO-mah
NEH-krop-se
neh-KRO-sis
neh-KROT-ik
neh-FROL-o-jist
neh-FROP-ah-the
nu-RAL-jah
nu-tro-PE-ne-ah
NU-tro-fil
of-thal-MOL-o-je
O-pe-oyd
os-te-o-JEN-ik
os-te-o-mah-LA-shah
o-TAL-jah
par-ah-sen-TE-sis
path-o-JEN-eh-sis
path-o-LOJ-ik
peh-rih-KAR-de-um
peh-rih-to-NE-al
fleh-BOT-o-me
PLAYT-let
PLUR-al
plur-o-DIN-e-ah
nu-MO-ne-ah
pol-e-morf-o-NU-kle-ar LU-ko-site
TO-sis
PUL-mo-nar-e
ra-de-OG-rah-fer
ra-de-o-THER-ah-pe
REK-to-seel
ri-no-RE-ah
spleh-no-MEG-ah-le
staf-ih-lo-KOK-si
strep-to-KOK-sis
thor-ah-cen-TE-sis
THROM-bo-site
throm-bo-site-o-PE-ne-ah
220
TERM
thrombophlebitis
tonsillar
tonsillitis
tracheostomy
tracheotomy
venule
PRONUNCIATION
throm-bo-fleh-BI-tis
TON-sih-lar
ton-sih-LI-tis
tra-ke-OS-to-me
tra-ke-OT-o-me
VEN-ule
Review Sheet
Write the meanings of each word part in the space provided and test
yourself. Check your answers with the information in the chapter or in
the Glossary (Medical Word Parts—English), at the end of this book.
Noun Suffixes
221
SUFFIX
-algia
-cele
-centesis
-coccus (-cocci)
-cyte
-dynia
-ectomy
-emia
-er
-genesis
-gram
-graph
-graphy
-ia
-ist
-itis
-logy
-lysis
-malacia
-megaly
-ole
-oma
-opsy
-osis
-pathy
-penia
-phobia
-plasia
-plasty
-ptosis
-rrhea
-sclerosis
-scope
-scopy
-stasis
-stomy
-therapy
-tomy
-trophy
-ule
-um, -ium
-us
-y
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Adjective Suffixes
222
SUFFIX
-ac, -iac
-al
-ar
-ary
-eal
-genic
-ic, -ical
-oid
-ose
-ous
-tic
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Combining Forms
223
COMBINING FORM
abdomin/o
acr/o
acu/o
aden/o
adip/o
amni/o
angi/o
arteri/o
arthr/o
axill/o
bi/o
blephar/o
bronch/o
carcin/o
cardi/o
chem/o
chondr/o
chron/o
col/o
cyst/o
encephal/o
erythr/o
hem/o
hepat/o
hydr/o
inguin/o
isch/o
lapar/o
laryng/o
leuk/o
lymph/o
mamm/o
mast/o
morph/o
muc/o
my/o
myel/o
necr/o
nephr/o
neur/o
neutr/o
nucle/o
ophthalm/o
opi/o
oste/o
ot/o
path/o
peritone/o
phag/o
phleb/o
plas/o
pleur/o
MEANING
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224
COMBINING FORM
pneumon/o
pulmon/o
radi/o
rect/o
ren/o
rhin/o
sarc/o
splen/o
staphyl/o
strept/o
thorac/o
thromb/o
tonsill/o
trache/o
ven/o
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Give the medical term for the following blood cells.
red blood cell ____________________________________________
clo ing cell _____________________________________________
white blood cell __________________________________________
Name five different types of white blood cells (the first le er is
given).
e ________________________________________
b ________________________________________
n ________________________________________
l ________________________________________
m _______________________________________
225
CHAPTER 4
226
Prefixes
CHAPTER SECTIONS:
Introduction 104
Combining Forms and Suffixes 104
Prefixes and Terminology 105
A Closer Look 114
Practical Applications 119
Exercises 120
Answers to Exercises 125
Pronunciation of Terms 126
Review Sheet 128
CHAPTER GOALS
• Define basic prefixes used in the medical language.
• Analyze medical terms that combine prefixes and other word elements.
• Learn about the Rh condition as an example of an antigen-antibody
reaction.
227
228
Introduction
This chapter on prefixes, like the preceding chapter on suffixes, gives
you practice in word analysis and provides a foundation for the study
of the terminology of body systems that follows.
The list of combining forms, suffixes, and meanings helps you
analyze terminology in the rest of the chapter. To support a broader
understanding, A Closer Look, beginning on page 114, contains more
detailed explanations of new terms.
Combining Forms and Suffixes
Combining Forms
COMBINING
FORM
carp/o
cis/o
cost/o
cutane/o
dactyl/o
duct/o
flex/o
furc/o
gloss/o
glyc/o
immun/o
morph/o
mort/o
nat/i
norm/o
ox/o
pub/o
seps/o
somn/o
son/o
tens/o
the/o
thel/o, theli/o
thyr/o
top/o
tox/o
trache/o
urethr/o
MEANING
wrist bones
cut
rib
skin
fingers, toes
lead, carry
bend
branching
tongue
sugar
protection
shape, form
death
birth
rule, order
oxygen
pubis (pubic bone); anterior portion of the pelvic or hipbone
infection
sleep
sound
force, strain, stretch
put, place
nipple
thyroid gland; shield (the shape of the thyroid gland resembled [-oid] a
shield to those who named it)
place, position, location
poison
windpipe, trachea
urethra
229
Suffixes
These suffixes are used in this chapter in combination with prefixes.
Some are complex suffixes that contain roots. For example, the suffix pnea contains a root pne, meaning breathing, and a final suffix -a,
meaning condition.
SUFFIX
-crine
-drome
-fusion
-gen
-lapse
-lysis
-meter
-mission
-or
-oxia
-partum
-phoria
-physis
-plasia
-plasm
-pnea
-ptom
-ptosis
-rrhea
-stasis
-trophy
MEANING
secrete
run
coming together; to pour
substance that produces
slide, fall, sag
breakdown, destruction, separation
measure
send
one who
oxygen
birth, labor
bear, carry; feeling (mental state)
grow
development, formation, growth
structure or formation
breathing
happening, occurrence
falling, drooping, prolapse
flow, discharge
stopping, controlling
development, nourishment
Prefixes and Terminology
Write the meaning of the medical term in the space provided.
Remember: the Evolve website provides the definition and audio
pronunciation for each term.
230
PREFIX MEANING TERMINOLOGY
MEANING
a-, an- no, not,
apnea ______________________________________________
without
anoxia _____________________________________________
abaway from
abnormal ___________________________________________
abductor ___________________________________________
A muscle that draws a limb away from the body.
HINT: Notice that in abductor, the b faces away from the a.
adtoward
adductor ____________________________________________
A muscle that draws a limb toward the body.
HINT: Notice that in adductor, the d faces toward the a.
adrenal glands _____________
These glands actually lie on top of each kidney. See Figure 4-1.
anaup, apart
anabolism __________________________________________
analysis ____________________________________________
Urinalysis (urin/o + [an]/alysis) is a laboratory examination of urine
that aids in the diagnosis of many medical conditions. In this term, lysis means separation.
antebefore,
ante cibum _________________________________________
forward
The word cibum means meals. The notation a.c., seen on prescription
orders, means before meals. You can guess that p.c. means after (post)
meals.
anteflexion _________________________________________
antepartum _________________________________________
antiagainst
antibiotic ___________________________________________
Antibiotics destroy or inhibit the growth of microorganisms such as
bacteria. Penicillin was the first antibiotic discovered and was in
widespread use by the 1940s. Many penicillin-like antibiotics have
been discovered since then and have shown valuable activity against
penicillin-resistant organisms.
antibody ____________________________________________
Protein produced against an antigen (foreign body).
antigen _____________________________________________
In this term, anti- is short for antibody. An antigen (bacterium or
virus) is a substance that stimulates the production of (-gen) an
antibody.
See A Closer Look: Antigens and Antibodies, page 114.
antisepsis __________________________________________
An antiseptic (-sis changes to -tic to form an adjective) substance
fights infection. Septicemia is a serious bacterial infection of the
blood.
antitoxin ___________________________________________
This is an antibody, often from an animal (such as a horse), that acts
against a toxin. An example is tetanus antitoxin given against
tetanus, an acute bacterial infection of the nervous system.
autoself, own
autoimmune disease ________________________________
bitwo
bifurcation _________________________________________
Normal spli ing into two branches, such as bifurcation of the trachea
to form the bronchi. The root furc means branching.
bilateral _____________________________________________
brady- slow
bradycardia _________________________________________
Usually, a pulse of less than 60; a slow heart rate. Tachycardia (tachymeans fast) is a pulse of more than 100 beats per minute.
catadown
catabolism ___________________________________________
231
PREFIX MEANING TERMINOLOGY
MEANING
conwith,
congenital anomaly
together
See A Closer Look: Congenital Anomaly, page 116.
connective __________________________________________
The root nect means to tie or bind. Connective tissue supports and
binds other body tissue and parts. Bone, cartilage, and fibrous tissue
are connective tissues.
contra- against,
contraindication _____________________________________
opposite
Contra- means against in this term.
contralateral ________________________________________
Contra- means opposite in this term. A stroke affecting the right side
of the brain may cause contralateral paralysis affecting the left arm
and leg.
dedown, lack dehydration _________________________________________
of
diathrough,
diameter ___________________________________________
complete
diarrhea ____________________________________________
dialysis _____________________________________________
Literal meaning is complete (dia-) separation (-lysis). In
hemodialysis, waste materials are separated from the blood via a
machine (artificial kidney) when the kidneys no longer function.
Another form of dialysis is peritoneal dialysis.
dysabnormal,
dyspnea ____________________________________________
bad
Often caused by respiratory or cardiac conditions, strenuous exercise,
difficult,
or anxiety.
painful
dysentery ___________________________________________
dystrophy ___________________________________________
Muscular dystrophy includes many inherited diseases that cause
muscular weakness and deterioration.
dysplasia ___________
ecout, ouside
ectopic pregnancy ___________________________________
Ectopic means pertaining to out of place and modifies the noun
“pregnancy.” See Figure 4-2.
endoin, within
endocardium ________________________________________
endoscope __________________________________________
endotracheal ________________________________________
An endotracheal tube, placed through the mouth into the trachea, is
used for giving oxygen and in general anesthesia procedures.
epiupon, on,
epithelium _________________________________________
above
eugood,
euphoria ___________________________________________
normal
Feeling of well-being.
euthyroid __________________________________________
Normal thyroid function.
exout, outside
exophthalmos _____________________________________
Protrusion of the eyeball associated with enlargement and overactivity
of the thyroid gland.
hemihalf
hemiglossectomy _____________________________________
232
PREFIX MEANING TERMINOLOGY
MEANING
hyper- excessive,
hyperglycemia _____________________________________
above
This is a sign of diabetes mellitus. Lack of insulin (type 1 diabetes)
or ineffective insulin (type 2 diabetes) causes high levels of sugar in
the blood.
hyperplasia ________________________________________
Increase in cell numbers. This is a characteristic of tumor growth.
hypertrophy ________________________________________
Increase in size of individual cells. Muscle, cardiac, and renal cells
exhibit hypertrophy when workload is increased. The opposite of
hypertrophy is atrophy (cells shrink in size). See Figure 4-3.
hypertension ________________________________________
High blood pressure occurs when the force of blood pushing against
the walls of arteries is consistently too high.
hypodeficient,
hypodermic injection ________________________________
under
hypoglycemia _______________________________________
innot
insomniac __________________________________________
ininto, within incision ____________________________________________
infrabeneath,
infracostal __________________________________________
under
interbetween
intercostal __________________________________________
Intercostal muscles lie between adjacent ribs.
intrain, within,
intravenous _________
into
macro- large
macrocephaly _______________________________________
This is a congenital anomaly. Often macrocephaly is associated with
excess fluid in the brain (hydrocephalus).
malbad
malaise ____________________________________________
(mal-AYZ) This is a French word meaning discomfort. It is a symptom
of illness often marking the onset of a disease.
malignant __________________________________________
From the Latin ignis, meaning fire. Benign (ben- = good) is
noncancerous, whereas malignant means cancerous.
metabeyond,
metacarpal bones _____________________________________
change
The five hand bones lie beyond the wrist bones but before the finger
bones (phalanges).
metamorphosis ______________________________________
Meta- means change in this term. The change in development from
the larval (caterpillar) stage to the adult (bu erfly) is a form of
metamorphosis. Embryonic (immature) stem cells spontaneously
change (undergo metamorphosis) to form different types of mature
cells.
metastasis __________________________________________
Meta- = beyond and -stasis = controlling, stopping. A metastasis is a
malignant tumor that has spread to a secondary location.
micro- small
microscope __________________________________________
microcephaly __________________________________________
Microcephaly is associated with a smaller, underdeveloped brain. Zika
virus infection during pregnancy can cause microcephaly.
neonew
neonatal ____________________________________________
The neonatal period is the interval from birth to 28 days.
neoplasm ___________________________________________
A neoplasm may be benign or malignant.
panall
pancytopenia ________________________________________
Deficiency of erythrocytes, leukocytes, and thrombocytes.
233
PREFIX MEANING TERMINOLOGY
MEANING
paraabnormal,
paralysis ____________________________________________
beside, near
Abnormal disruption of the connection between nerve and muscle.
Originally from the Greek paralusis, meaning separation or loosening
on one side, describing the loss of movement on one side of the body
(occurring in stroke patients).
parathyroid glands ___________________________________
Para- means beside. The four parathyroid glands are located behind the
thyroid gland. They secrete a hormone that regulates the calcium
levels in blood and tissues.
perthrough
percutaneous _______________________________________
perisurrounding pericardium ________________________________________
polymany, much
polymorphonuclear __________________________________
polyneuritis _________________________________________
postafter, behind
postmortem ________________________________________
postpartum _________________________________________
prebefore, in
precancerous _______________________________________
front of
prenatal ____________________________________________
probefore,
prodrome __________________________________________
forward
Prodromal signs and symptoms (rash, fever) appear before the actual
illness (such as chickenpox) and signal its onset. Altered mood,
fatigue, flashes of light, or stiff muscles may accompany the prodromal
migraine aura that occurs before the actual headache.
prolapse ____________________________________________
The suffix -lapse means to slide, sag, or fall. See Figure 4-4. A prolapse
of the eyelid is commonly called ptosis (blepharoptosis).
prosbefore,
prosthesis __________________________________________
forward
An artificial limb is a prosthesis. Figure 4-5 shows Amy PalmieroWinters running with a prosthetic leg.
reback, again
relapse ____________________________________________
A disease or its signs and symptoms return after an apparent recovery.
remission __________________________________________
Signs and symptoms lessen and the patient feels be er. Remission may
be spontaneous or the result of treatment. In some cases, a permanent
remission means the disease is cured.
recombinant DNA ____________________________________
Genetic engineering uses recombinant DNA techniques. See A Closer
Look: Recombinant DNA, page 116.
retrobehind,
retroperitoneal ______________________________________
backward
retroflexion _________________________________________
An abnormal position of an organ, such as the uterus, bent or tilted
backward.
subunder
subcutaneous _______________________________________
supra- above,
suprapubic _________________________________________
upper
The pubic bones form the anterior part of the hip bone as shown in
Figure 4-6A. A suprapubic catheter is useful in draining the bladder
above the pubic bone. See Figure 4-6B.
234
PREFIX MEANING TERMINOLOGY
MEANING
syn-,
together,
syndactyly __________________________________________
symwith
See Figure 4-7.
synthesis ___________________________________________
In protein synthesis, complex proteins are built up from simpler amino
acids.
syndrome __________________________________________
See A Closer Look: Syndromes, page 117.
symbiosis _________________________________________
HINT: Before the le ers b, m, and p, syn- becomes sym-. The term
symptom is an important example. Be careful about spelling! Don’t
forget the p in symptom.
symmetry __________________________________________
Equality of parts on opposite sides of the body. What is asymmetry?
symphysis __________________________________________
A symphysis is a joint in which the bony surfaces are firmly united by
a layer of fibrocartilage. See Figure 4-6C.
tachy- fast
tachypnea ___________________________________________
(tah-KIP-ne-ah)
transacross,
transfusion _________________________________________
through
Transfer of blood or blood parts from one person to another.
transurethral _______________________________________
See A Closer Look: Transurethral Resection of the Prostate
Gland, page 118.
ultrabeyond,
ultrasonography _____________________________________
excess
See A Closer Look: Ultrasonography, page 118.
unione
unilateral __________________________________________
235
FIGURE 4-1 Adrenal glands. These are endocrine glands
located above each kidney. One of the hormones they secrete is
adrenaline (epinephrine). It causes bronchial tubes to widen, the
heart to beat more rapidly and blood pressure to rise.
FIGURE 4-2 Ectopic pregnancy. Normal pregnancy
implantation is in the upper portion of the uterus. Ectopic
pregnancy occurs most commonly in a fallopian tube (i.e., tubal
pregnancy). In this condition, the fetus is not viable. Surgery
often is necessary to remove the ectopic tissue. Tubal surgery
may damage a fallopian tube, and scar tissue can cause future
pregnancy problems.
236
FIGURE 4-3 Differences between normal cells, hyperplasia,
hypertrophy, and atrophy.
FIGURE 4-4 Prolapse of the uterus. In first-degree prolapse,
the uterus descends into the vaginal canal. In second-degree
prolapse, the body of the uterus is still within the vagina, but the
cervix protrudes from the vaginal orifice (opening). In thirddegree prolapse (not pictured), the entire uterus projects outside
the orifice. As treatment, the uterus may be held in position by a
plastic pessary (oval supporting object) that is inserted into the
vagina. Some affected women may require hysterectomy
(removal of the uterus).
237
FIGURE 4-5 Prosthesis. Amy Palmiero-Winters is the first
female with a prosthetic leg to finish the Badwater 135, a 135mile race from Badwater in Death Valley to Mount Whitney,
California.
FIGURE 4-6 A. Bones of the pelvic (hip) bone. B.
Suprapubic catheter. C. Pubic symphysis. This is the area in
which the pubic bones have grown together.
238
FIGURE 4-7 Syndactyly. The foot on the left (pale) shows
syndactyly (webbed toes). The foot on the right (darker) shows
normal toes. Syndactyly is a hereditary, congenital anomaly of
fingers or toes.
Sleep Apnea
Sleep apnea occurs when breathing suddenly stops during sleep. A
CPAP (continuous positive airway pressure) machine is used to keep
airways open.
Anti- and Ante-
Be careful not to confuse these prefixes. Pay close a ention to their
different pronunciations. Anti- is pronounced an-tih, and ante- is
pronounced an-te.
Autoimmune Disease
In an autoimmune disease, the body makes antibodies against its own
good cells and tissues, causing inflammation and injury. Examples of
autoimmune disorders are rheumatoid arthritis, affecting joints; celiac
disease, affecting the intestinal tract; and Graves disease, affecting the
thyroid gland.
Peritoneal Dialysis
In peritoneal dialysis, a special fluid is inserted into the peritoneal
cavity through a tube in the abdomen. Waste materials such as urea
239
seep into the fluid from the blood during a period of time. The fluid
and the wastes are then drained from the peritoneal cavity. See Figure
7-16 on page 223.
Signs and Symptoms
A sign is an objective finding that is perceived by an examiner, such
as fever, rash, or hyperglycemia. A symptom (from Greek, symptoma,
meaning that which happens) is a subjective change in condition as
perceived by the patient. Examples of symptoms are loss of appetite,
abdominal pain, and fatigue (tiredness). Both signs and symptoms are
useful clues in the diagnosis of a disease, such as diabetes mellitus.
Intra-, Inter-, Infra-
Be careful not to confuse these prefixes: intra- means in, within, into;
inter- means between; infra- means beneath, under.
Symbiosis
Symbiosis occurs when two organisms live together in close
association, either for mutual benefit or not. Examples are:
• Bacteria in the intestines and the cells lining the intestines benefit
each other.
• Parasites (tapeworms and fleas) live off another organism and are
harmful to the host.
In psychiatry, symbiosis is a relationship between two people who
are emotionally dependent on each other.
240
A Closer Look
Antigens and Antibodies; the Rh Condition
An antigen, usually a foreign substance (such as a poison, virus, or
bacterium), stimulates the production of antibodies. Antibodies are
protein substances made by white blood cells in response to the
presence of foreign antigens. For example, the flu virus (antigen) enters
the body, causing the production of antibodies in the bloodstream.
These antibodies then bind to and mark for destruction the antigens
(viruses) that produced them. The reaction between an antigen and an
antibody is an immune response (immun/o means protection). See
Figure 4-8. When you receive a vaccine, you actually are receiving dead
or weakened antigens that stimulate white blood cells (lymphocytes) to
make antibodies. These antibodies remain in your blood to protect
against those specific antigens when encountered in the future.
FIGURE 4-8 Immune response. When antigens (bacteria)
enter the body through a flesh wound, antibodies are produced to
destroy the antigens.
Another example of an antigen-antibody reaction is the Rh condition.
A person who is Rh-positive (Rh+) has a protein coating (antigen) on his
or her red blood cells (RBCs). This specific antigen factor is something
that the person is born with and is normal. People who are Rh-negative
(Rh−) have normal RBCs as well, but their red cells lack the Rh factor
antigen.
241
If an Rh− woman and an Rh+ man conceive an embryo, the embryo
may be Rh− or Rh+. A dangerous condition arises only when the embryo
is Rh+ (because this is different from the Rh− mother). During delivery
of the first Rh+ baby, some of the baby's blood cells containing Rh+
antigens can escape into the mother's bloodstream. This sensitizes the
mother so that she produces a low level of antibodies to the Rh+ antigen.
Because this occurs at delivery, the first baby is generally not affected
and is normal at birth. Sensitization can also occur after a miscarriage,
abortion, or blood transfusions (with Rh+ blood).
Difficulties arise with the second Rh+ pregnancy. If this embryo also is
Rh+, during pregnancy the mother's acquired antibodies (from the first
pregnancy) enter the embryo's bloodstream. These antibodies a ack
and destroy the embryo’s Rh+ RBCs (hemolysis). The affected infant is
born with hemolytic disease of the newborn (HDN).
One of the clinical signs of HDN is jaundice (yellow skin
pigmentation). Jaundice results from excessive destruction of RBCs.
When RBCs break down, the hemoglobin within the cells produces
bilirubin (a chemical pigment). High levels of bilirubin in the
bloodstream (hyperbilirubinemia) cause jaundice. To prevent bilirubin
from affecting the brain cells of the infant, newborns are treated with
exposure to bright lights (phototherapy). The light decomposes the
bilirubin, which is then excreted from the infant's body.
Physicians administer Rh immunoglobulin to an Rh− woman within
72 hours after each Rh+ delivery, abortion, or miscarriage. The globulin
binds to Rh+ cells that escape into the mother's circulation and prevents
formation of Rh+ antibodies. This protects future babies from
developing HDN. Figure 4-9 reviews the Rh condition as an example of
an antigen-antibody action.
242
FIGURE 4-9 Rh condition as an example of an antigenantibody reaction.
Congenital Anomaly
An anomaly is an irregularity in a structure or organ. Examples of
congenital anomalies (those that an infant is born with) include
webbed fingers or toes (syndactyly), heart defects, and clubbed feet. See
Figure 4-10A. Some congenital anomalies are hereditary (passed to the
infant through chromosomes from the father or mother, or both),
whereas others are produced by factors present during pregnancy. For
example, when a pregnant woman consumes high levels of alcohol
during pregnancy, there is often a pa ern of physical and mental
defects in her infant at birth. See Figure 4-10B.
243
FIGURE 4-10 Congenital anomalies. A, Clubfoot is a
hereditary congenital anomaly. The “clubbing” may affect one or
both feet. B, Fetal alcohol syndrome (FAS) is a congenital
anomaly caused by environmental factors during pregnancy.
Notice the facial features of FAS: skin folds in corners of eyes;
long, smooth groove between the nose and upper lip; thin upper
lip; and flat nasal bridge.
Recombinant DNA
Recombinant DNA technology is the process of taking a gene (a region
of DNA) from one organism and inserting it into the DNA of another
organism. For example, recombinant techniques are used to
manufacture insulin outside the body. The gene that codes for insulin
(i.e., contains the recipe for making insulin) is cut out of a human
chromosome (using special enzymes) and transferred into a bacterium,
such as Escherichia coli (E. coli). The bacterium then contains the gene for
making human insulin and, because it multiplies very rapidly, can
produce insulin in large quantities. Diabetic patients, unable to make
their own insulin, can use this synthetic product (see Figure 4-11).
CRISPR is an acronym for new DNA editing tool that changes DNA
sequences to turn off genes or to replace them with new versions.
CRISPR means clustered regularly-interspaced short palindromic
repeats!
244
FIGURE 4-11 Recombinant DNA and insulin production.
Syndromes
A syndrome (from the Greek dromos, meaning a course for running) is a
group of signs or symptoms that appear together to produce a typical
clinical picture of a disease or inherited abnormality. For example, Reye
syndrome is characterized by vomiting, swelling of the brain, increased
intracranial pressure, hypoglycemia, and dysfunction of the liver. It
may occur in children after a viral infection that has been treated with
aspirin.
Marfan syndrome is an inherited connective tissue disorder marked
by a tall, thin body type with long, “spidery” fingers and toes
(arachnodactyly), elongated head, and heart, blood vessel, and
ophthalmic abnormalities (see Figure 4-12).
245
FIGURE 4-12 Marfan syndrome. A and B show people with
Marfan's. Note the unusually tall body type and long, spidery
fingers. The Olympic swimmer Michael Phelps (not pictured) has
Marfan syndrome. His height is 6′4″ and his arm span is 6′7″.
Transurethral Resection of the Prostate Gland
In transurethral resection of the prostate gland (TURP), a portion of
the prostate gland is removed with an instrument (resectoscope) passed
through (trans-) the urethra. The procedure is indicated when prostatic
tissue increases (hyperplasia) and interferes with urination. This
condition is called benign prostatic hyperplasia or BPH. Figure 4-13
shows a TURP procedure.
246
FIGURE 4-13 Transurethral resection of the prostate
(TURP). The resectoscope contains a light, valves for controlling
irrigated fluid, and an electrical loop that cuts tissue and seals
blood vessels.
Ultrasonography
Ultrasonography is a diagnostic technique using ultrasound waves
(inaudible sound waves) to produce an image of an organ or tissue. A
machine records ultrasonic echoes as they pass through different types
of tissue. X-rays are not used! Echocardiograms are ultrasound images
of the heart. Figure 4-14 shows a fetal ultrasound image (sonogram).
247
FIGURE 4-14 Ultrasonography. A, Notice the facial features of
this beautiful 30-week-old fetus, in a (very) early “baby picture” of
my granddaughter, Beatrix Bess Thompson! B, Bebe, smiling, at
3 months of age. (Courtesy Dr. Elizabeth Chabner Thompson.)
Practical Applications
Check your answers with the Answers to Practical Applications on
page 126. You should find helpful explanations there.
A Useful Weapon Against Anemia
Anemia is a major problem for many patients who are in chronic renal
failure. This is because as renal function decreases, the kidneys secrete
less erythropoietin, a hormone that stimulates the production of red
blood cells. Under normal conditions, when the body senses a decrease
in red blood cells or a deficiency in the supply of oxygen, more
erythropoietin is produced, thus increasing the number of
erythrocytes.
Epoetin alfa (Epogen or Procrit) is a man-made form of human
erythropoietin. It is genetically engineered through recombinant DNA
technology and stimulates bone marrow to make and release red blood
cells. As the hematocrit rises, patients experience increased energy,
appetite, and greater stamina.
The FDA has approved Epogen for treating anemia in dialysis
patients and in patients who are in chronic renal failure, but not on
dialysis. It is also effective in counteracting the myelosuppressive
effects of chemotherapy. Other hematopoietic drugs produced with
recombinant DNA technology are Neupogen (filgrastim) for
neutropenia and thrombopoietin (TPO) for thrombocytopenia.
248
1. Anemia is a major problem for patients in chronic renal failure
because
a. the kidney overproduces erythropoietin
b. patients may go into heart failure and lose consciousness
c. patients produce less of a hormone that stimulates
production of erythrocytes
2. The type of erythropoietin that is used for these patients is
a. made in a laboratory by using pieces of DNA that code for
the hormone
b. made from the blood of other patients
c. given by bone marrow transfusion
3. The hematocrit is
a. a measurement of the volume of white and red blood cells
b. the percentage of red blood cells in a volume of blood
c. lower in people with greater stamina and energy levels
4. Patients go on dialysis when
a. they are in chronic renal failure
b. they have a low hematocrit
c. they are undergoing chemotherapy
5. Side effects of myelosuppressiive chemotherapy may be treated
by
a. cytotoxic agents
b. Epogen, Neupogen, and thrombopoietin
c. hemodialysis or peritoneal dialysis
249
Exercises
Remember to check your answers carefully with the Answers to
Exercises, pages 125–126.
A Give the meanings of the following prefixes.
1. ante_____________________________________________
2. ab_____________________________________________
3. ana_____________________________________________
4. anti_____________________________________________
5. a-, an_____________________________________________
6. ad_____________________________________________
7. auto_____________________________________________
8. cata_____________________________________________
9. brady_____________________________________________
10. contra_____________________________________________
11. bi_____________________________________________
12. con_____________________________________________
B Match the listed terms with the meanings that
follow.
250
adductor
adrenal
analysis
anoxia
anteflexion
antepartum
antisepsis
apnea
bilateral
bradycardia
congenital anomaly
contralateral
1. bending forward
_____________________________________________
________________________
2. muscle that carries the limb toward the body
_____________________________________________
________________________
3. before birth
_____________________________________________
________________________
4. slow heartbeat
_____________________________________________
________________________
5. gland located near (above) each kidney
_____________________________________________
________________________
6. absence of breathing
_____________________________________________
________________________
251
7. pertaining to the opposite side
_____________________________________________
________________________
8. against infection
_____________________________________________
________________________
9. to separate
_____________________________________________
________________________
10. pertaining to two (both) sides
_____________________________________________
________________________
11. condition of no oxygen in tissues
_____________________________________________
________________________
12. irregularity present at birth
_____________________________________________
________________________
C Select from the listed terms to match the
descriptions that follow.
anabolism
antibiotic
antibody
antigen
antitoxin
autoimmune disease
catabolism
congenital anomaly
contraindication
252
1. chemical substance, such as erythromycin (-mycin
= mold), made from molds and used against
bacterial life
_____________________________________________
________________________
2. process of burning food (breaking it down) and
releasing the energy stored in the food
_____________________________________________
________________________
3. reason that a doctor would advise against taking a
specific medication
_____________________________________________
________________________
4. disorder in which the body's own leukocytes make
antibodies that damage its own good tissue
_____________________________________________
_______________________
5. a foreign agent (virus or bacterium) that causes
production of antibodies
_____________________________________________
________________________
6. an antibody that acts against poisons that enter the
body
_____________________________________________
______
7. process of building up proteins in cells by pu ing
together small pieces of proteins called amino acids
_____________________________________________
________________________
8. protein made by lymphocytes in response to the
presence in the blood of a specific antigen
253
_____________________________________________
________________________
D Give the meanings of the following prefixes.
1. ec_____________________________________________
2. dys_____________________________________________
3. de_____________________________________________
4. dia_____________________________________________
5. hemi_____________________________________________
6. hypo_____________________________________________
7. epi_____________________________________________
8. hyper_____________________________________________
9. endo_____________________________________________
10. eu_____________________________________________
11. in_____________________________________________
12. inter_____________________________________________
13. intra_____________________________________________
254
14. infra_____________________________________________
15. macro_____________________________________________
16. micro_____________________________________________
E Complete the following terms, based on their
meanings as given.
1. normal thyroid function:
________________________ thyroid
2. painful breathing: ________________________ pnea
3. pregnancy that is out of place (outside the uterus):
________________________ topic
4. instrument to visually examine within the body:
endo
_____________________________________________
5. removal of half of the tongue:
________________________ glossectomy
6. good (exaggerated) feeling (of well-being):
________________________ phoria
7. pertaining to within the windpipe: endo
_____________________________________________
8. blood condition of less than normal sugar:
________________________ glycemia
9. condition (congenital anomaly) of large head:
________________________ cephaly
10. pertaining to between the ribs:
________________________ costal
11. pertaining to within a vein: intra
_____________________________________________
255
12. condition of abnormal formation (of cells): dys
____________________________________
13. condition of excessive formation (numbers of
cells): _____________ plasia
14. structure (membrane) that forms the inner lining
of the heart: endo _______________________
15. pertaining to below the ribs: infra
_____________________________________________
16. blood condition of excessive amount of sugar:
hyper
_____________________________________________
17. A group of congenital disorders involving
abnormal development of muscle mass and
strength is: muscular
____________________________________
18. Zika virus infection during pregnancy can be a
cause of decreased development of an infant’s
head and brain:
____________________________________ cephaly
F Match the listed terms with the meanings that
follow.
dehydration
dialysis
diarrhea
exophthalmos (proptosis)
incision
insomnia
malaise
malignant
metamorphosis
256
p
metastasis
microscope
pancytopenia
1. vague feeling of bodily discomfort
_____________________________________________
________________________
2. inability to sleep
_____________________________________________
________________________
3. lack of water
_____________________________________________
________________________
4. spread of a cancerous tumor to a secondary organ
or tissue
_____________________________________________
________________________
5. instrument used to view small objects
_____________________________________________
________________________
6. a cut into an organ or tissue
_____________________________________________
________________________
7. outward bulging of the eyeballs
_____________________________________________
________________________
8. condition of change in shape or form
_____________________________________________
________________________
9. watery discharge of wastes from the colon
_____________________________________________
________________________
257
10. deficiency of all (blood) cells
_____________________________________________
________________________
11. separation of wastes from the blood by using a
machine that does the job of the kidney
_____________________________________________
________________________
12. harmful, cancerous
_____________________________________________
________________________
G Give the meanings of the following prefixes.
1. mal_____________________________________________
2. pan_____________________________________________
3. per_____________________________________________
4. meta_____________________________________________
5. para_____________________________________________
6. peri_____________________________________________
7. poly_____________________________________________
8. post_____________________________________________
9. pro_____________________________________________
258
10. pre_____________________________________________
11. sub_____________________________________________
12. supra_____________________________________________
13. re_____________________________________________
14. retro_____________________________________________
15. tachy_____________________________________________
16. syn_____________________________________________
17. uni_____________________________________________
18. trans_____________________________________________
19. neo_____________________________________________
20. epi_____________________________________________
H Underline the prefix in the following terms, and
give the meaning of the entire term.
1. pericardium
_____________________________________________
________________________
2. percutaneous
_____________________________________________
________________________
259
3. retroperitoneal
_____________________________________________
________________________
4. suprapubic
_____________________________________________
________________________
5. polyneuritis
_____________________________________________
________________________
6. retroflexion
_____________________________________________
________________________
7. transurethral
_____________________________________________
________________________
8. subcutaneous
_____________________________________________
________________________
9. tachypnea
_____________________________________________
________________________
10. unilateral
_____________________________________________
________________________
11. prosthesis
_____________________________________________
________________________
12. bilateral
_____________________________________________
________________________
260
13. symptom
_____________________________________________
________________________
14. syndrome
_____________________________________________
________________________
I Match the listed terms with the meanings that
follow.
adrenal
neoplasm
paralysis
parathyroid
prodrome
prolapse
recombinant DNA
relapse
remission
syndactyly
syndrome
ultrasonography
1. return of a disease or its symptoms
_____________________________________________
________________________
2. loss of movement in muscles
_____________________________________________
________________________
3. congenital anomaly in which fingers or toes are
webbed (formed together)
261
_____________________________________________
________________________
4. four endocrine glands that are located near
(behind) another endocrine gland in the neck
_____________________________________________
________________________
5. glands that are located above the kidneys
_____________________________________________
________________________
6. symptoms that come before the actual illness
_____________________________________________
________________________
7. technique of transferring genetic material from one
organism into another
_____________________________________________
________________________
8. sliding, sagging downward or forward
_____________________________________________
________________________
9. new growth or tumor
_____________________________________________
________________________
10. process of using sound waves to create an image
of organs and structures in the body
_____________________________________________
________________________
11. group of signs and symptoms that occur together
and indicate a particular disorder
_____________________________________________
________________________
262
12. symptoms lessen and a patient feels be er
_____________________________________________
________________________
J Complete the following terms, based on their
meanings as given.
1. pertaining to new birth: neo
_____________________________________________
________________________
2. after death: post
_____________________________________________
________________________
3. spread of a cancerous tumor: meta
_____________________________________________
________________________
4. branching into two: bi
_____________________________________________
________________________
5. increase in development (size of cells): hyper
_____________________________________________
________________________
6. pertaining to a chemical that works against
bacterial life: ________________________ biotic
7. hand bones (beyond the wrist):
________________________ carpals
8. protein produced by leukocytes to fight foreign
organisms: anti
______________________________________
9. group of symptoms that occur together:
________________________ drome
10. surface or skin tissue of the body:
________________________ thelium
263
K Circle the correct bold term to complete the
following sentences.
1. Dr. Tate felt that Mrs. Snow's condition of
thrombocytopenia was a clear (analysis,
contraindication, synthesis) to performing elective
surgery.
2. Medical science was revolutionized by the
introduction of (antigens, antibiotics, antibodies)
in the 1940s. Now some infections can be treated
with only one dose.
3. Robert's 82-year-old grandfather complained of
(malaise, dialysis, insomnia) despite taking the
sleeping medication that his doctor prescribed.
4. During her pregnancy, Ms. Payne described
pressure on her (pituitary gland, parathyroid
gland, pubic symphysis), making it difficult for
her to find a comfortable position, even when
seated.
5. Many times, people with diabetes accidentally take
too much insulin. This results in lowering their
blood sugar so much that they may be admi ed to
the emergency department with (hyperplasia,
hypoglycemia, hyperglycemia).
6. Before his migraine headaches began, John noticed
changes in his eyesight, such as bright spots,
zigzag lines, and double vision. His physician told
him that these were (symbiotic, exophthalmic,
prodromal) symptoms.
7. After hiking in the Grand Canyon without an
adequate water supply, Julie experienced
(hyperglycemia, dehydration, hypothyroidism).
264
8. At 65 years of age, Paul Smith often felt fullness in
his urinary bladder but had difficulty urinating. He
visited his (cardiologist, nephrologist, urologist),
who examined his prostate gland and diagnosed
(hyperplasia, atrophy, ischemia). The doctor
advised (intracostal, transurethral, peritoneal)
resection of Paul's prostate.
9. After running the Boston Marathon, Elizabeth felt
nauseated and dizzy. She realized that she was
experiencing (malaise, euphoria, hypoglycemia)
and drank a sports drink containing sugar, which
made her feel be er.
10. While she was taking an antibiotic that reacted
with sunlight, Ruth's physician advised her that
sunbathing was (unilateral, contraindicated,
contralateral) and might cause a serious sunburn.
11. Puerperal (pertaining to childbirth) fever was an
iatrogenic infection; it was carried from one
woman to another by the doctor before the days of
(antigens, antibodies, antisepsis).
12. Dysplastic nevi (abnormal pigmented lesions or
moles) on a patient's skin may be a (precancerous,
metastatic, unilateral) sign of malignant skin
cancer called melanoma.
13. Nerve cells of the brain may (relapse,
hypertrophy, atrophy) in old age because of
ischemia caused by restricted blood flow.
14. Changes in cell growth resulting in cells that differ
in size, shape, and appearance are the result of
chronic inflammation and irritation. When the
condition occurs in the uterine cervix, it is known
as cervical (prolapse, paralysis, dysplasia).
265
Answers to Exercises
A
1. before, forward
2. away from
3. up, apart
4. against
5. no, not, without
6. toward
7. self, own
8. down
9. slow
10. against, opposite
11. two
12. together, with
B
1. anteflexion
2. adductor
3. antepartum
4. bradycardia
5. adrenal
6. apnea
7. contralateral
266
8. antisepsis
9. analysis
10. bilateral
11. anoxia
12. congenital anomaly
C
1. antibiotic
2. catabolism
3. contraindication
4. autoimmune disease
5. antigen
6. antitoxin
7. anabolism
8. antibody
D
1. out, outside
2. abnormal, bad, difficult, painful. HINT: Think of
the word dysfunctional.
3. down, lack of
4. through, complete
5. half
6. deficient, under
7. upon, on, above
267
8. excessive, above, beyond
9. in, within
10. good, well
11. in, not
12. between
13. within
14. below, inferior
15. large
16. small
E
1. euthyroid
2. dyspnea
3. ectopic
4. endoscope
5. hemiglossectomy
6. euphoria
7. endotracheal
8. hypoglycemia
9. macrocephaly
10. intercostal
11. intravenous
12. dysplasia
13. hyperplasia
268
14. endocardium
15. infracostal
16. hyperglycemia
17. dystrophy
18. microcephaly
F
1. malaise
2. insomnia
3. dehydration
4. metastasis
5. microscope
6. incision
7. exophthalmos (proptosis)
8. metamorphosis
9. diarrhea
10. pancytopenia
11. dialysis
12. malignant
G
1. bad
2. all
3. through
4. change, beyond
269
5. near, beside, abnormal
6. surrounding
7. many, much
8. after, behind
9. before, forward
10. before, in front of
11. under
12. above
13. back, again
14. behind, backward
15. fast
16. together, with
17. one
18. across, through
19. new
20. above, upon, on
H
1. pericardium—membrane surrounding the heart
2. percutaneous—pertaining to through the skin
3. retroperitoneal—pertaining to behind the peritoneum
4. suprapubic—above the pubic bone
5. polyneuritis—inflammation of many nerves
6. retroflexion—bending backward
270
7. transurethral—pertaining to through the urethra
8. subcutaneous—pertaining to below the skin
9. tachypnea—rapid, fast breathing
10. unilateral—pertaining to one side
11. prosthesis—artificial limb or part of the body
(literally, to put or place forward)
12. bilateral—both sides
13. symptom—subjective change of condition as
observed by a patient
14. syndrome—group of objective findings that
characterize an abnormal condition
I
1. relapse
2. paralysis
3. syndactyly
4. parathyroid
5. adrenal
6. prodrome
7. recombinant DNA
8. prolapse
9. neoplasm
10. ultrasonography
11. syndrome
12. remission
271
J
1. neonatal
2. postmortem
3. metastasis
4. bifurcation
5. hypertrophy
6. antibiotic
7. metacarpals
8. antibody
9. syndrome
10. epithelium
K
1. contraindication
2. antibiotics
3. insomnia
4. pubic symphysis
5. hypoglycemia
6. prodromal
7. dehydration
8. urologist; hyperplasia; transurethral
9. hypoglycemia
10. contraindicated
11. antisepsis
272
12. precancerous
13. atrophy
14. dysplasia
Answers to Practical Applications
1. C
2. A
3. B
4. B
5. B
Pronunciation of Terms
The terms you have learned in this chapter are presented here with
their pronunciations. The CAPITAL le ers indicate the accented
syllable.
The meanings for all the terms are in the Mini-Dictionary beginning
on page 897. You can also hear each term pronounced on the Evolve
website (h p://evolve.elsevier.com/Chabner/language/).
273
TERM
abductor
abnormal
adductor
adrenal glands
anabolism
analysis
anoxia
ante cibum (a.c.)
anteflexion
antepartum
antibiotic
antibody
antigen
antisepsis
antitoxin
apnea
autoimmune disease
benign
bifurcation
bilateral
bradycardia
catabolism
congenital anomaly
connective tissue
contraindication
contralateral
dehydration
dialysis
diameter
diarrhea
dysentery
dysplasia
dyspnea
dystrophy
ectopic pregnancy
endocardium
endoscope
endotracheal
epithelium
euphoria
euthyroid
exophthalmos
hemiglossectomy
hyperglycemia
hyperplasia
hypertension
hypertrophy
hypodermic injection
hypoglycemia
incision
infracostal
insomniac
PRONUNCIATION
ab-DUK-tor
ab-NOR-mal
ah-DUK-tor
ah-DRE-nal glanz
ah-NAB-o-liz-im
ah-NAL-ih-sis
ah-NOK-se-ah
AN-te SE-bum
an-te-FLEK-shun
an-te-PAR-tum
an-tih-bi-OT-ik
AN-tih-bod-e
AN-tih-jen
an-tih-SEP-sus
an-tih-TOX-in
AP-ne-ah
aw-to-ih-MUNE dih-ZEEZ
beh-NINE
bi-fur-KA-shun
bi-LAT-er-al
bra-de-KAR-de-ah
kah-TAB-o-liz-im
con-JEN-ih-al ah-NOM-ah-le
kon-NEK-tiv TIH-shu
kon-trah-in-dih-KA-shun
kon-trah-LAT-er-al
de-hi-DRA-shun
di-AL-ih-sis
di-AM-eh-ter
di-ah-RE-ah
DIS-en-ter-e
dis-PLA-ze-ah
DISP-ne-ah
DIS-tro-fe
ek-TOP-ik PREG-nan-se
en-do-KAR-de-um
EN-do-skope
en-do-TRA-ke-al
ep-ih-THE-le-um
u-FOR-e-ah
u-THI-royd
ek-sof-THAL-mos
hem-e-glos-SEK-to-me
hi-per-gli-SE-me-ah
hi-per-PLA-ze-ah
hi-per-TEN-shun
hi-PER-tro-fe
hi-po-DER-mik in-JEK-shun
hi-po-gli-SE-me-ah
in-SIZH-un
in-frah-KOS-tal
in-SOM-ne-ak
274
TERM
intercostal
intravenous
macrocephaly
malaise
malignant
metacarpal bones
metamorphosis
metastasis
microcephaly
microscope
neonatal
neoplasm
pancytopenia
paralysis
parathyroid glands
percutaneous
pericardium
polymorphonuclear
polyneuritis
postmortem
postpartum
precancerous
prenatal
prodrome
prolapse
prosthesis
recombinant DNA
relapse
remission
retroflexion
retroperitoneal
subcutaneous
suprapubic
symbiosis
symmetry
symphysis
symptom
syndactyly
syndrome
synthesis
tachypnea
transfusion
transurethral
ultrasonography
unilateral
PRONUNCIATION
in-ter-KOS-tal
in-trah-VE-nus
mak-ro-SEH-fah-le
mal-AYZ
mah-LIG-nant
met-ah-KAR-pal bones
met-ah-MOR-fuh-sis
meh-TAS-tah-sis
mi-kro-SEH-fah-le
MI-kro-skope
ne-o-NA-tal
NE-o-plazm
pan-si-to-PE-ne-ah
pah-RAL-ih-sis
par-ah-THI-royd glanz
per-ku-TA-ne-us
peh-rih-KAR-de-um
pol-e-mor-fo-NU-kle-ar
pol-e-nu-RI-tis
post-MOR-tem
post-PAR-tum
pre-KAN-ser-us
pre-NA-tal
PRO-drohm
PRO-laps
pros-THE-sis
re-KOM-bih-nant DNA
RE-laps
re-MIH-shun
reh-tro-FLEK-shun
reh-tro-peh-rih-to-NE-al
sub-ku-TA-ne-us
su-prah-PU-bik
sim-be-O-sis
SIM-met-re
SIM-fih-sis
SIMP-tum
sin-DAK-tih-le
SIN-drohm
SIN-theh-sis
tah-KIP-ne-ah
tranz-FU-zhun
tranz-u-RE-thral
ul-trah-so-NOG-rah-fe
u-nih-LAT-er-al
Review Sheet
275
Write the meanings of each word part in the space provided, and test
yourself. Check your answers with the information in the chapter or in
the Glossary (Medical Word Parts—English) at the end of the book.
Prefixes
276
PREFIX
a-, anabadanaanteantiautobibradycataconcontradediadysecen-, endoepieuexhemihyperhypoininfrainterintramacromalmetamicroneopanparaperperipolypostpreproprosreretrosubsuprasyn-, symtachytransultrauni-
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
277
Prefixes with Similar Meanings
PREFIX
a-, an-, inante-, pre-, proanti-, contracon-, syn-, symde-, catadia-, per-, transdys-, malec-, ecto-, exendo-, in-, intraepi-, hyper-, suprahypo-, infra-, subre-, retro-, postultra-, meta-
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Combining Forms
COMBINING FORM
carp/o
cost/o
cutane/o
dactyl/o
duct/o
flex/o
gloss/o
glyc/o
immun/o
later/o
morph/o
mort/o
nat/i
necr/o
norm/o
ophthalm/o
ox/o
pub/o
ren/o
seps/o
somn/o
son/o
tens/o
the/o
thyr/o
top/o
tox/o
trache/o
urethr/o
ven/o
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
278
Suffixes
SUFFIX
-crine
-drome
-fusion
-gen
-lapse
-lysis
-meter
-mission
-or
-partum
-phoria
-physis
-plasia
-plasm
-pnea
-ptom
-ptosis
-rrhea
-stasis
-trophy
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
279
CHAPTER 5
280
Digestive System
CHAPTER SECTIONS:
Introduction 132
Anatomy and Physiology 132
Vocabulary 142
Terminology 145
Pathology of the Digestive System 151
In Person: Living with Crohn's 162
Exercises 163
Answers to Exercises 171
Pronunciation of Terms 173
CHAPTER GOALS
• Name the organs of the digestive system and describe their locations and
functions.
• Define combining forms for organs and know the meaning of related
terminology.
• Describe signs, symptoms, and disease conditions affecting the digestive
system.
281
282
Introduction
The digestive system is divided between Chapters 5 and 6. Chapter 5
covers the anatomy, physiology, pathology, and basic terminology of
the system. Chapter 6 introduces additional terminology and a review
of digestive system terms, plus laboratory tests, clinical procedures, and
abbreviations. My reason for not combining the chapters is that I did
not want to overwhelm you with an extraordinarily long chapter so
early in your study. In my own teaching, I find that my students are
grateful for this separation, and especially for the breather and review
of terminology in Chapter 6.
My choice to begin with the digestive system is based on a perception
that this body system (resembling a long conveyor belt with the mouth
at the entrance and anus at the exit) is one of the more straightforward
and easiest to understand. Keep in mind, however, that the book is
organized so that you may begin study of the body systems with any
chapter to create the order that best reflects your interests.
The digestive or gastrointestinal tract begins with the mouth, where
food enters, and ends with the anus, where solid waste material leaves
the body. The four functions of the system are ingestion, digestion,
absorption, and elimination.
First, complex food material taken into the mouth is ingested.
Second, it is digested, or broken down, mechanically and chemically as
it travels through the gastrointestinal tract. Digestive enzymes speed up
chemical reactions and aid the breakdown (digestion) of complex
nutrients. Complex proteins are digested to simpler amino acids;
complicated sugars are reduced to simple sugars, such as glucose; and
large fat molecules (triglycerides) are broken down to simpler
substances such as fa y acids. Digestion occurs in the mouth, stomach,
and small intestine.
Third, through absorption, nutrients from digested food pass
through the lining cells or epithelium of the small intestine and into the
bloodstream. Nutrients then travel to all cells of the body. Cells then
break down nutrients in the presence of oxygen to release energy. Cells
also use amino acid nutrients to build up large protein molecules
needed for growth and development. In addition, fat molecules are
absorbed into lymphatic vessels from the intestine.
The fourth function of the digestive system is elimination of the solid
waste materials that cannot be absorbed into the bloodstream. The large
intestine concentrates these solid wastes, called feces, and the wastes
finally pass out of the body through the anus.
283
Anatomy and Physiology
Oral Cavity
The gastrointestinal tract begins with the oral cavity. Oral means
pertaining to the mouth (or/o). Label Figure 5-1 as you learn the major
parts of the oral cavity.
FIGURE 5-1 Oral cavity.
The cheeks [1] form the walls of the oval-shaped oral cavity, and the
lips [2] surround the opening to the cavity.
The hard palate [3] forms the anterior portion of the roof of the
mouth, and the muscular soft palate [4] lies posterior to it. Rugae are
irregular ridges in the mucous membrane covering the anterior portion
of the hard palate. The uvula [5], a small soft tissue projection, hangs
from the soft palate. It aids production of sounds and speech.
The tongue [6] extends across the floor of the oral cavity, and muscles
a ach it to the lower jawbone. It moves food around during mastication
(chewing) and deglutition (swallowing). Papillae, small raised areas on
the tongue, contain taste buds that are sensitive to the chemical nature
of foods and allow discrimination of different tastes as food moves
across the tongue.
284
The tonsils [7], masses of lymphatic tissue located in depressions of
the mucous membranes, lie on both sides of the oropharynx (part of the
throat near the mouth). They are filters to protect the body from the
invasion of microorganisms and produce lymphocytes, disease-fighting
white blood cells.
The gums [8] are the fleshy tissue surrounding the sockets of the
teeth [9]. Figure 5-2 shows a dental arch with 16 permanent teeth (there
are 32 permanent teeth in the entire oral cavity). The names of the teeth
are labeled in Figure 5-2.
FIGURE 5-2 Upper permanent teeth within the dental arch.
The buccal surface faces the cheek, whereas the lingual
surface faces the tongue. The labial surface faces the lips.
Dentists refer to the labial and buccal surfaces as the facial
(faci/o = face) surface.
Figure 5-3 shows the inner anatomy of a tooth. Label it as you read
the following description:
285
FIGURE 5-3 Anatomy of a tooth.
A tooth consists of a crown [1], which shows above the gum line, and
a root [2], which lies within the bony tooth socket. The outermost layer
of the crown, the enamel [3], protects the tooth. It is the hardest tissue in
the human body. Dentin [4], the main substance of the tooth, lies
beneath the enamel and extends throughout the crown. Dentin's color
ranges from creamy white to yellow, and it affects the color of teeth
because enamel is translucent. The cementum covers, protects, and
supports the dentin in the root. A periodontal membrane surrounds the
cementum and holds the tooth in place in the tooth socket.
The pulp [5] lies underneath the dentin. This soft and delicate tissue
fills the center of the tooth. Blood vessels, nerve endings, connective
tissue, and lymphatic vessels are within the pulp canal (also called the
root canal). Root canal therapy often is necessary when disease or
abscess (pus collection) occurs in the pulp canal. A dentist opens the
tooth from above and cleans the canal of infected tissue, nerves, and
blood vessels. The canal is then disinfected and filled with material to
prevent the entrance of microorganisms that could cause decay.
Three pairs of salivary glands (Figure 5-4) surround and empty into
the oral cavity. These exocrine glands produce saliva, which lubricates
the mouth. Saliva contains important digestive enzymes as well as
healing growth factors such as cytokines. Saliva is released from a
parotid gland [1], submandibular gland [2], and sublingual gland [3]
on both sides of the mouth. Narrow ducts carry saliva into the oral
cavity. The glands produce about 1.5 liters of saliva daily.
286
FIGURE 5-4 Salivary glands.
Pharynx
Refer to Figure 5-5. The pharynx or throat is a muscular tube, about 5
inches long, lined with a mucous membrane. It serves as a passageway
both for air traveling from the nose (nasal cavity) to the windpipe
(trachea) and for food traveling from the oral cavity to the esophagus.
When swallowing (deglutition) occurs, a cartilaginous flap of tissue, the
epiglo is, covers the trachea so that food cannot enter and become
lodged there. See Figure 5-5A and B.
287
FIGURE 5-5 Deglutition (swallowing). A, Epiglottis closes
over the trachea as the bolus of food passes down the pharynx
toward the esophagus. B, Epiglottis opens as the bolus moves
down the esophagus.
Your Mother Was Right! Don’t Talk While
You’re Eating!
Talking while eating causes the epiglo is to open, so food can
accidentally enter the trachea, causing you to choke.
Figure 5-6 shows the passageway for food as it travels from the
esophagus through the gastrointestinal tract. Label it as you read the
following paragraphs.
288
FIGURE 5-6 The gastrointestinal tract.
Esophagus
The esophagus [1] is a 9- to 10-inch fibromuscular tube extending from
the pharynx to the stomach. Peristalsis is the involuntary, progressive,
rhythmic contraction of muscles in the wall of the esophagus (and other
gastrointestinal organs), propelling a bolus (mass of food) down toward
the stomach. The process is like squeezing a marble through a rubber
tube.
289
Stomach
Food passes from the esophagus into the stomach [2]. The stomach
(Figure 5-7) has three main parts: fundus (upper portion), body (middle
section), and antrum (lower portion). Rings of muscle called sphincters
control the openings into and leading out of the stomach. They prevent
food from regurgitating (flowing backward from the normal direction).
The lower esophageal sphincter (LES) relaxes and contracts to move
food from the esophagus into the stomach. The pyloric sphincter allows
food to leave the stomach and enter the small intestine when it is ready.
Folds in the mucous membrane (mucosa) lining the stomach are called
rugae. The rugae increase surface area for digestion and contain glands
that produce the enzyme pepsin to begin digestion of proteins.
Hydrochloric acid also is secreted to digest protein and kill any bacteria
remaining in food.
FIGURE 5-7 Parts of the stomach. The fundus and body
(often referred to collectively as the fundus) are a reservoir for
ingested food and an area for action by acid and pepsin (gastric
enzyme). The antrum is a muscular grinding chamber that
breaks up food and feeds it gradually into the duodenum.
The stomach prepares food for the small intestine, where further
digestion and absorption into the bloodstream take place. Food leaves
290
the stomach in 1 to 4 hours or longer, depending on the amount and
type of food eaten.
Small Intestine (Small Bowel)
(Continue labeling Figure 5-6 on page 136.)
The small intestine (small bowel) extends for 20 feet from the pyloric
sphincter to the first part of the large intestine. It has three parts. The
first section, the duodenum [3], is only 1 foot long. It receives food from
the stomach as well as bile from the liver [4] and gallbladder [5] and
pancreatic juices from the pancreas [6]. Enzymes and bile help digest
food before it passes into the second part of the small intestine, the
jejunum [7], about 8 feet long. The jejunum connects with the third
section, the ileum [8], about 11 feet long. The ileum a aches to the first
part of the large intestine.
Millions of tiny, microscopic projections called villi line the walls of
the small intestine. The tiny capillaries (microscopic blood vessels) in
the villi absorb the digested nutrients into the bloodstream and lymph
vessels. Figure 5-8 shows several different views of villi in the lining of
the small intestine.
291
FIGURE 5-8 Villi in the lining of the small intestine. Villi
increase the surface area for absorption of nutrients.
Large Intestine (Large Bowel)
(Continue labeling Figure 5-6 on page 136.)
The large intestine extends from the end of the ileum to the anus. It
has three main components: the cecum, the colon, and the rectum. The
cecum [9] is a pouch on the right side that connects to the ileum at the
ileocecal valve (sphincter). The appendix [10] hangs from the cecum.
The appendix has no clear function and can become inflamed and
infected when clogged or blocked. The colon, about 5 feet long, has four
named segments: ascending, descending, transverse, and sigmoid. The
ascending colon [11] extends from the cecum to the undersurface of the
liver, where it turns to the left (hepatic flexure) to become the transverse
colon [12]. The transverse colon passes horizontally to the left toward
the spleen and then turns downward (splenic flexure) into the
descending colon [13]. The sigmoid colon [14], shaped like an S
(sigmoid means resembling the Greek le er sigma, which curves like
the le er S), begins at the distal end of the descending colon and leads
292
into the rectum [15]. The rectum terminates in the lower opening of the
gastrointestinal tract, the anus [16].
The large intestine receives the fluid waste products of digestion (the
material unable to pass into the bloodstream) and stores these wastes
until they can be released from the body. Because the large intestine
absorbs most of the water within the waste material, the body can expel
solid feces (stools). Defecation is the expulsion or passage of feces from
the body through the anus. Diarrhea, or passage of watery stools,
results from reduced water absorption into the bloodstream through the
walls of the large intestine.
Liver, Gallbladder, and Pancreas
Three important additional organs of the digestive system—the liver,
gallbladder, and pancreas—play crucial roles in the proper digestion
and absorption of nutrients. Label Figure 5-9 as you study the
following:
FIGURE 5-9 Liver, gallbladder, and pancreas. The ampulla
of Vater is at the junction of the pancreatic duct and common bile
duct entering the duodenum.
The liver [1], located in the right upper quadrant (RUQ) of the
abdomen, manufactures a thick, orange-black, sometimes greenish,
fluid called bile. Bile contains cholesterol (a fa y substance), bile acids,
and several bile pigments. One of these pigments, bilirubin, is
produced from the breakdown of hemoglobin during normal red blood
293
cell destruction. Bilirubin travels via the bloodstream to the liver, where
it is conjugated or converted into a water-soluble form. Conjugated
bilirubin is then added to bile and enters the intestine (duodenum).
Bacteria in the colon degrade bilirubin into a variety of pigments that
give feces a brownish color. Bilirubin and bile leave the body in feces.
If the bile duct is blocked or the liver damaged and unable to excrete
bilirubin into bile, the bilirubin remains in the bloodstream, causing
jaundice (hyperbilirubinemia)—yellow discoloration of the skin,
whites of the eyes, and mucous membranes. In addition, stools may
turn lighter in color because of less bilirubin and bile excreted into the
gastrointestinal tract. Figure 5-10 reviews the path of bilirubin from red
blood cell destruction (hemolysis) to elimination with bile in the feces.
294
FIGURE 5-10 Bilirubin pathway from bloodstream to
elimination in feces. Increased blood levels of unconjugated
bilirubin indicate ongoing hemolysis (red blood cell destruction).
Increased blood levels of conjugated bilirubin indicate obstruction
of bile ducts. Both types of bilirubin are elevated in the blood of
patients with liver disease.
(Continue labeling Figure 5-9.)
The liver continuously releases bile, which then travels through the
hepatic duct and meets the cystic duct. The cystic duct leads to the
gallbladder [2], a pear-shaped sac under the liver, which stores and
concentrates the bile for later use. After meals, in response to the
presence of food in the stomach and duodenum, the gallbladder
contracts, forcing the bile out the cystic duct into the common bile duct
[3]. Meanwhile, the pancreas [4] secretes pancreatic juices (enzymes)
that are released into the pancreatic duct, which joins with the common
bile duct just as it enters the duodenum [5]. The duodenum thus
receives a mixture of bile and pancreatic juices.
Bile has a detergent-like effect on fats in the duodenum. In the process
of emulsification, bile breaks apart large fat globules, creating more
surface area so that enzymes from the pancreas can digest the fats.
295
y
p
g
Without bile, most of the fat taken into the body remains undigested,
and stools may appear fa y.
Besides producing bile, the liver has several other vital and important
functions:
• Maintaining normal blood glucose (sugar) levels.
The liver removes excess glucose from the
bloodstream and stores it as glycogen (starch) in
liver cells. When the blood sugar level becomes
dangerously low, the liver converts stored glycogen
back into glucose via a process called
glycogenolysis. In addition, when the body needs
sugar, the liver can convert proteins and fats into
glucose, by a process called gluconeogenesis.
• Manufacturing blood proteins, such as albumin
and those necessary for blood clo ing
• Releasing bilirubin, a pigment in bile
• Clearing drugs and poisons (toxins) from the
blood
The portal vein brings blood to the liver from the intestines. Nutrients
from digested foods pass into the portal vein directly after being
absorbed into the capillaries of the small intestine, thus giving the liver
the first chance to use the nutrients.
The pancreas (Figure 5-11) is both an exocrine and an endocrine
organ. As an exocrine gland, it produces enzymes to digest starch, such
as amylase (amyl/o = starch, -ase = enzyme); to digest fat, such as lipase
(lip/o = fat); and to digest proteins, such as protease (prote/o = protein).
These pass into the duodenum through the pancreatic duct.
296
FIGURE 5-11 The pancreas and its functions.
As an endocrine gland (secreting into the bloodstream), the pancreas
secretes insulin. This hormone, needed to help release sugar from the
blood, acts as a carrier to bring glucose into cells of the body to be used
for energy.
Figure 5-12 is a flow chart that traces the pathway of food through the
gastrointestinal tract.
297
FIGURE 5-12 Pathway of food through the gastrointestinal tract.
Vocabulary
The following list reviews many of the terms introduced in this chapter.
Short definitions and additional information reinforce your
298
understanding of the terms. All of the terms are included in the
Pronunciation of Terms section later in the chapter.
299
absorption
Passage of materials through the walls of the small intestine into the
bloodstream.
amino acids
Small building blocks of proteins, released when proteins are digested.
amylase
Enzyme (-ase) secreted by the pancreas and salivary glands to digest starch
(amyl/o).
anus
Terminal end or opening of the digestive tract to the outside of the body.
appendix
Blind pouch hanging from the cecum (in the right lower quadrant [RLQ]). It
literally means hanging (pend/o) onto (ap-, which is a form of ad-).
bile
Digestive juice made in the liver and stored in the gallbladder. It breaks up
(emulsifies) large fat globules. Bile originally was called gall (Latin bilis,
meaning gall or anger), probably because it has a bi er taste. It is composed
of bile pigments (colored materials), cholesterol, and bile salts.
bilirubin
Pigment released by the liver in bile.
bowel
Intestine.
canine teeth
Pointed, dog-like teeth (canine means pertaining to dog) next to the
incisors. Also called cuspids or eyeteeth.
cecum
First part of the large intestine.
colon
Portion of the large intestine consisting of the ascending, transverse,
descending, and sigmoid segments.
common bile Carries bile from the liver and gallbladder to the duodenum. Also called
duct
the choledochus.
defecation
Elimination of feces from the digestive tract through the anus.
deglutition
Swallowing. HINT: pronunciation is de-glu-TISH-un.
dentin
Primary material found in teeth. It is covered by the enamel in the crown
and a protective layer of cementum in the root.
digestion
Breakdown of complex foods to simpler forms.
duodenum
First part of the small intestine. Duo = 2, den = 10; the duodenum measures
12 inches long.
elimination
Removal of materials from the body; in the digestive system, the removal of
indigestible materials as feces.
emulsification Breaking up large fat globules into smaller globules. This increases the
surface area that enzymes can use to digest the fat.
enamel
Hard, outermost layer of a tooth.
enzyme
Chemical that speeds up a reaction between substances. Digestive enzymes
break down complex foods to simpler substances. Enzymes are given
names that end in -ase.
esophagus
Tube connecting the throat to the stomach. Eso- means inward; phag/o
means swallowing.
fa y acids
Substances produced when fats are digested.
feces
Solid wastes; stool. The term fecal means pertaining to feces.
gallbladder
Small sac under the liver; stores bile. HINT: gallbladder is one word!
glucose
Simple sugar.
glycogen
Starch; glucose is stored in the form of glycogen in liver cells.
hydrochloric Substance (strong acid) produced in the stomach; aids digestion.
acid
ileum
Third part of the small intestine from the Greek eilos, meaning twisted.
When the abdomen was viewed at autopsy, the intestine appeared twisted,
and the ileum often was an area of obstruction.
incisor
Any one of four front teeth in the dental arch.
insulin
Hormone produced by the endocrine cells of the pancreas. It helps
transport sugar into body cells.
jejunum
Second part of the small intestine. The Latin jejunus means empty; this part
of the intestine was always empty when a body was examined after death.
HINT: pronunciation is jeh-JU-num.
300
lipase
liver
lower
esophageal
sphincter
(LES)
mastication
molar teeth
Pancreatic enzyme necessary to digest fats.
Large organ located in the RUQ of the abdomen. The liver secretes bile;
stores sugar, iron, and vitamins; produces blood proteins; destroys wornout red blood cells; and filters out toxins. The normal adult liver weighs
about
to 3 pounds.
Ring of muscles between the esophagus and the stomach. Also called
cardiac sphincter.
Chewing.
Three large, flat teeth at the back of the mouth, on either side of the dental
arch. Premolar teeth are two teeth, before the molars.
palate
Roof of the mouth. The hard palate lies anterior to the soft palate and is
supported by the upper jawbone (maxilla). The soft palate is the posterior
fleshy part between the mouth and the throat.
pancreas
Organ behind the stomach; produces insulin (for transport of sugar into
cells) and enzymes (for digestion of foods).
papillae
Small projections on the tongue. Taste buds (taste receptor cells) are located
within the papillae (pap-IL-e).
parotid gland Salivary gland within the cheek, just anterior to the ear. Note the literal
meaning of parotid (par- = near; ot/o = ear).
peristalsis
Rhythmic contractions of the tubular organs. In the gastrointestinal tract,
peristalsis moves the contents through at different rates: stomach, 0.5 to 2
hours; small intestine, 2 to 6 hours; and colon, 6 to 72 hours. Peri- means
surrounding; -stalsis is constriction. HINT: pronunciation is peh-rihSTAL-sis.
pharynx
Throat, the common passageway for food from the mouth and for air from
the nose.
portal vein
Large vein bringing blood to the liver from the intestines.
protease
Enzyme that digests protein.
pulp
Soft tissue within a tooth, containing nerves and blood vessels.
pyloric
Ring of muscle at the end of the stomach, near the duodenum. From the
sphincter
Greek pyloros, meaning gatekeeper. It is normally closed, but opens when a
wave of peristalsis passes over it.
pylorus
Distal region of the stomach, opening to the duodenum.
rectum
Last section of the large intestine, connecting the end of the colon and the
anus.
rugae
Ridges on the hard palate and the wall of the stomach. HINT:
pronunciation is RU-guy.
saliva
Digestive juice produced by salivary glands. Saliva contains the enzyme
amylase, which begins the digestion of starch to sugar.
salivary
Parotid, sublingual, and submandibular glands.
glands
sigmoid colon Lower, S-shaped segment of the colon, just before the rectum; empties into
the rectum.
sphincter
Circular ring of muscle that constricts a passage or closes a natural opening.
stomach
Muscular organ that receives food from the esophagus. The stomach's parts
are the fundus (proximal section), body (middle section), and antrum
(distal section).
triglycerides Fat molecules composed of three parts fa y acids and one part glycerol.
Triglycerides (fats) are a subgroup of lipids. Another type of lipid is
cholesterol.
uvula
Soft tissue hanging from the middle of the soft palate. The Latin uva means
bunch of grapes.
301
villi (singular: Microscopic projections in the wall of the small intestine that absorb
villus)
nutrients into the bloodstream.
Portal Vein
Notice the relationship of the portal vein (also called hepatic portal
vein) between the intestines and the liver (Figure 5-13). This vein is not
a true vein because it doesn't conduct blood directly to the heart as do
other veins. In liver disease, blood backs up into the portal vein,
causing portal hypertension (high blood pressure) and esophageal
varices. See page 155.
FIGURE 5-13 Portal vein and its relationship to the liver and
small intestine.
Terminology
Write the meaning of the medical term in the space provided. Check
the Pronunciation of Terms on pages 173–176 for any unfamiliar words.
Parts of the Body
302
FIGURE 5-14 Stages of appendicitis. A, Obstruction and
bacterial infection cause red, swollen, and inflamed appendix. B,
Pus and bacteria invade the wall of the appendix. C, Pus
perforates (ruptures through) the wall of the appendix into the
abdomen, leading to peritonitis (inflammation of the peritoneum).
FIGURE 5-15 A. Locations of stomas in the ileum and colon. B.
Colostomy care.
FIGURE 5-16 Three types of anastomoses. These are
examples of an enteroenterostomy. The suffix -stomy, when used
with two or more combining forms (enter/o and enter/o), indicates
the surgical creation of a new opening between those parts of the
body.
303
FIGURE 5-17 Mesentery. The omentum and mesocolon are
parts of the mesentery. The omentum (raised in this figure)
actually hangs down like an apron over the intestines. The
mesentery contains blood and lymph vessels. The lymph nodes
in the mesentery are important indicators in the spread of colon
cancer (staging of colon cancer).
304
COMBINING
MEANING TERMINOLOGY
MEANING
FORM
an/o
anus
perianal _______________________________________
append/o
appendix
appendectomy _______________________________________
appendic/o
appendicitis _______________________________________
See Figure 5-14.
bucc/o
cheek
buccal mucosa
_______________________________________
A mucosa is a mucous membrane lining cavities or canals that
open to the outside of the body.
cec/o
cecum
cecal _______________________________________
celi/o
belly,
celiac _______________________________________
abdomen
Abdomin/o and lapar/o also mean abdomen. Celiac disease is
damage to the lining of the small intestine, occurring as a
reaction to eating gluten.
cheil/o
lip
cheilosis _______________________________________
Labi/o also means lip.
cholecyst/o
gallbladder
cholecystectomy
_______________________________________
Chol/e = gall, bile.
choledoch/o
common
choledochotomy _______________________________________
bile duct
col/o
colon
colostomy _______________________________________
The suffix -stomy, when used with a combining form for an
organ, means an opening to the outside of the body. A stoma is
an opening between an organ and the surface of the body
(Figure 5-15A and B).
colon/o
colon
colonic _______________________________________
colonoscopy _______________________________________
dent/i
tooth
dentibuccal _______________________________________
Odont/o also means tooth.
duoden/o
duodenum duodenal _______________________________________
enter/o
intestines,
enterocolitis _______________________________________
usually
HINT: When two combining forms for gastrointestinal
small
organs are in a term, the one for the organ closer to the mouth
intestine
appears first.
enteroenterostomy
_______________________________________
New opening between two previously unconnected parts of the
small intestine. This is an anastomosis, which is any surgical
connection between two parts, such as vessels, ducts, or bowel
segments (ana = up, stom = opening, -sis = state of) (Figure 516).
mesentery _______________________________________
Part of the double fold of peritoneum that stretches around the
organs in the abdomen, the mesentery holds the organs in place.
Literally, it lies in the middle (mes-) of the intestines, a
membrane a aching the intestines to the muscle wall at the back
of the abdomen (Figure 5-17).
parenteral _______________________________________
Par (from para-) means apart from in this term. An intravenous
line brings parenteral nutrition directly into the bloodstream,
bypassing the intestinal tract (enteral nutrition). Parenteral
injections may be subcutaneous or intramuscular as well.
305
COMBINING
MEANING TERMINOLOGY
MEANING
FORM
esophag/o
esophagus
esophageal _______________________________________
HINT:Changing the suffix from -al to -eal softens the final g
(eh-sof-ah-JE-al).
faci/o
face
facial _______________________________________
gastr/o
stomach
gastrostomy _______________________________________
gingiv/o
gums
gingivitis _______________________________________
gloss/o
tongue
hypoglossal _______________________________________
Lingu/o also means tongue.
hepat/o
liver
hepatoma _______________________________________
Also called hepatocellular carcinoma.
hepatomegaly
_______________________________________
ile/o
ileum
ileocecal sphincter
_______________________________________
Also called the ileocecal valve.
ileitis _______________________________________
ileostomy _______________________________________
See Figure 5-15A, page 146.
jejun/o
jejunum
choledochojejunostomy
_______________________________________
An anastomosis.
gastrojejunostomy
_______________________________________
This is part of a gastric bypass procedure. See Figure 6-7B,
page 187.
labi/o
lip
labial _______________________________________
lapar/o
abdomen
laparoscopy _______________________________________
A form of minimally invasive surgery (MIS). Examples are
laparoscopic cholecystectomy (Figure 5-28, page 160) and
laparoscopic appendectomy.
lingu/o
tongue
sublingual _______________________________________
mandibul/o
lower jaw, submandibular _______________________________________
mandible
odont/o
tooth
orthodontist _______________________________________
Orth/o means straight.
periodontist _______________________________________
endodontist _______________________________________
Performs root canal therapy.
or/o
mouth
oral _______________________________________
Stomat/o also means mouth.
palat/o
palate
palatoplasty _______________________________________
Procedure to repair cleft palate and cleft lip; repair of a cleft
palate.
pancreat/o
pancreas
pancreatitis _______________________________________
peritone/o
peritoneum
peritonitis _______________________________________
The e of the root has been dropped in this term.
pharyng/o
throat
pharyngeal _______________________________________
palatopharyngoplasty
_______________________________________
Used to treat cases of snoring or sleep apnea caused by
obstructions in the throat or nose.
306
COMBINING
MEANING TERMINOLOGY
MEANING
FORM
proct/o
anus and
proctologist _______________________________________
rectum
pylor/o
pyloric
pyloroplasty _______________________________________
sphincter
rect/o
rectum
rectocele _______________________________________
sialaden/o
salivary
sialadenitis _______________________________________
gland
sigmoid/o
sigmoid
sigmoidoscopy _______________________________________
colon
stomat/o
mouth
stomatitis _______________________________________
uvul/o
uvula
uvulectomy _______________________________________
Substances
COMBINING
MEANING TERMINOLOGY
MEANING
FORM
amyl/o
starch
amylase _______________________________________
The suffix -ase means enzyme.
bil/i
gall, bile
biliary _______________________________________
The biliary tract includes the organs (liver and gallbladder)
and ducts (hepatic, cystic, and common bile ducts) that secrete,
store, and empty bile into the duodenum.
bilirubin/o
bilirubin
hyperbilirubinemia
(bile
_______________________________________
pigment)
chol/e
gall, bile
cholelithiasis
_______________________________________
Lith/o means stone or calculus; -iasis means abnormal
condition.
chlorhydr/o
hydrochloric
achlorhydria
acid
_______________________________________
Absence of gastric juice is associated with gastric carcinoma.
gluc/o
sugar
gluconeogenesis
_______________________________________
Liver cells make new sugar from fats and proteins.
glyc/o
sugar
hyperglycemia _______________________________________
glycogen/o
glycogen,
glycogenolysis
animal
_______________________________________
starch
Liver cells change glycogen back to glucose when blood sugar
levels drop.
lip/o
fat, lipid
lipoma _______________________________________
lith/o
stone
lithogenesis _______________________________________
prote/o
protein
protease _______________________________________
py/o
pus
pyorrhea _______________________________________
Periodontitis; an advanced stage of periodontal disease
(gingivitis).
sial/o
saliva,
sialolith _______________________________________
salivary
steat/o
fat
steatorrhea _______________________________________
Improperly digested (malabsorbed) fats will appear in the feces.
307
Suffixes
SUFFIX MEANING TERMINOLOGY
MEANING
-ase
enzyme
lipase ________________________________________
Enzymes speed up chemical reactions. Lipase aids in the digestion of
fats. In all types of liver disease, liver enzyme levels may be elevated,
indicating damage to liver cells. Signs and symptoms include malaise,
anorexia, hepatomegaly, jaundice, and abdominal pain.
-chezia defecation,
hematochezia ________________________________________
elimination
(he-mat-o-KE-ze-ah) Bright red blood is found in the feces.
of wastes
-iasis
abnormal
choledocholithiasis ________________________________________
condition
meal
postprandial ________________________________________
prandial
Post cibum (p.c.), seen on wri en prescriptions, also means after
meals.
Cholecyst/o and Cyst/o
Don't confuse cholecyst/o (gallbladder) with cyst/o, which is the
urinary bladder.
Ileum and Ilium
Don't confuse the ileum, which is the third part of the small intestine,
with the ilium, uppermost and largest part of the pelvis (hip bone).
Chol/e and Col/o
Don't confuse chol/e, which means gall or bile, with col/o, which
indicates the colon! The context of the term will help you determine the
correct spelling.
Pyorrhea and Pyuria
Pyorrhea is discharge (-rrhea) of pus from gums, and pyuria is
presence of pus in urine (sign of a urinary tract infection).
308
Pathology of the Digestive System
This section presents medical terms that describe signs and symptoms
(clinical indications of illness) and pathologic conditions of the
gastrointestinal tract. Sentences following each definition describe the
etiology (eti/o = cause) of the illness and treatment. When the etiology
(cause) is not understood, the condition is idiopathic (idi/o = unknown).
You can find a list of drugs prescribed to treat gastrointestinal signs and
symptoms and conditions in Chapter 21, Pharmacology.
Signs and Symptoms
A sign is an objective finding—such as an increase in body
temperature, a rash, or a sound heard on listening to the chest—
indicating the presence of disease as perceived by an examiner. By
contrast, a symptom is a subjective sensation or change in health—
such as itching, pain, fatigue, or nausea—as experienced by the
patient. Clearly, the same feature may be noticed by both doctor and
patient, which makes it at once both a sign and a symptom!
Signs and Symptoms
309
FIGURE 5-18 A. Ascites, or abnormal intraperitoneal fluid, can
result from conditions such as liver disease, peritonitis, and
ovarian cancer. B. Ascites in a male patient. The photograph
was taken after paracentesis (puncture to remove fluid from the
abdomen) was performed. Notice the gynecomastia (condition of
female-type breasts) in this patient due to an excess of estrogen,
which can accompany cirrhosis, especially in persons with
alcoholism.
310
FIGURE 5-19 Jaundice due to liver disease.
311
anorexia
ascites
borborygmi
(singular:
borborygmus)
constipation
diarrhea
dysphagia
eructation
flatus
hematochezia
jaundice
(icterus)
melena
Lack of appetite.
Anorexia (-orexia = appetite) often is a sign of malignancy or liver
disease. Anorexia nervosa is loss of appetite associated with emotional
problems such as anger, anxiety, and irrational fear of weight gain. It is
an eating disorder and is discussed along with a similar eating
disorder, bulimia nervosa, in Chapter 22.
Abnormal accumulation of fluid in the abdomen (Figure 5-18A and
B).
This condition occurs when fluid passes from the bloodstream and
collects in the peritoneal cavity. It can be a sign of neoplasm or
inflammatory disorders in the abdomen, venous hypertension (high
blood pressure) caused by liver disease (cirrhosis), or heart failure.
Treatment for ascites includes administration of diuretic drugs and
paracentesis to remove abdominal fluid.
Rumbling or gurgling noises produced by the movement of gas,
fluid, or both in the gastrointestinal tract.
Signs of hyperactive intestinal peristalsis, borborygmi (bowel sounds)
often are present in cases of gastroenteritis and diarrhea.
Difficulty in passing stools (feces).
When peristalsis is slow, stools are dry and hard. A diet with plentiful
fruits, vegetables, and water is helpful. Laxatives and cathartics are
medications to promote movement of stools. Chronic idiopathic
constipation (CIC) is persistent constipation without an identifiable
cause.
Frequent passage of loose, watery stools.
Abrupt onset of diarrhea immediately after eating suggests acute
infection or toxin in the gastrointestinal tract. Untreated, severe
diarrhea may lead to dehydration. Antidiarrheal drugs are helpful.
Difficulty in swallowing.
This sensation feels like a “lump in the throat” when a swallowed bolus
fails to progress, either because of a physical obstruction (obstructive
dysphagia) or because of a motor disorder in which esophageal
peristalsis is not coordinated (motor dysphagia).
Gas expelled from the stomach through the mouth.
Eructation produces a characteristic sound and also is called belching
(burping).
Gas expelled through the anus.
Flatulence is the presence of excessive gas in the stomach and the
intestines. One sign of a bowel obstruction is the inability to pass flatus.
Passage of fresh, bright red blood from the rectum.
The cause of hematochezia is usually hemorrhoids, but can also be
colitis, ulcers, polyps, or cancer.
Yellow-orange coloration of the skin and whites of the eyes caused
by high levels of bilirubin in the blood (hyperbilirubinemia). See
Figure 5-19.
Jaundice can occur when (1) excessive destruction of erythrocytes, as in
hemolysis, causes excess bilirubin in the blood; (2) malfunction of liver
cells (hepatocytes) due to liver disease prevents the liver from
excreting bilirubin with bile; or (3) obstruction of bile flow, such as
from choledocholithiasis or tumor, prevents bilirubin in bile from being
excreted into the duodenum.
Black, tarry stools; feces containing digested blood.
This clinical sign usually reflects a condition in which blood has had
time to be digested (acted on by intestinal juices) and results from
312
nausea
steatorrhea
bleeding in the upper gastrointestinal tract (duodenal ulcer). A positive
result on stool guaiac testing (see page 183) indicates blood in the stool.
Unpleasant sensation in the stomach with a tendency to vomit.
Common causes are motion sickness, early pregnancy, and viral
gastroenteritis. Nausea and vomiting may be symptomatic of a
perforation (hole in the wall) of an abdominal organ; obstruction of a
bile duct, stomach, or intestine; or exposure to poisons.
Fat in the feces.
Steatorrhea is production of frothy, foul-smelling fecal ma er that often
floats in the toilet. Improper digestion or absorption of fat causes fat to
remain in the intestine. This may occur with disease of the pancreas
(pancreatitis) when pancreatic enzymes are not excreted. It also is a
sign of intestinal disease that involves malabsorption of fat.
313
Pathologic Conditions
Oral Cavity and Teeth
FIGURE 5-20 Normal teeth and gums and pathologic
conditions. A, Normal teeth and gums. B, Aphthous stomatitis. C,
Dental caries. D, Herpetic stomatitis. E, Oral leukoplakia. F,
Gingivitis.
314
aphthous
stomatitis
dental
caries
herpetic
stomatitis
oral
leukoplakia
periodontal
disease
Inflammation of the mouth with small, painful ulcers.
The ulcers associated with this condition are commonly called canker
(KANK-er) sores; the cause is unknown (Figure 5-20B).
Tooth decay.
Dental plaque results from the accumulation of foods, proteins from
saliva, and necrotic debris on the tooth enamel. Bacteria grow in the
plaque and cause production of acid that dissolves the tooth enamel,
resulting in a cavity (area of decay) (Figure 5-20C). If the bacterial
infection reaches the pulp of the tooth, root canal therapy may be
necessary.
Inflammation of the mouth caused by infection with the herpesvirus.
Painful fluid-filled blisters on the lips, palate, gums, and tongue,
commonly called fever blisters or cold sores (Figure 5-20D). It is caused
by herpes simplex virus type 1 (HSV1). Herpes genitalis (due to HSV2)
involves the reproductive organs. Both conditions are highly contagious.
White plaques or patches on the mucosa of the mouth.
This precancerous lesion (Figure 5-20E) can result from chronic tobacco
use (pipe smoking or chewing tobacco). Malignant potential is assessed
by microscopic study of biopsied tissue.
Inflammation and degeneration of gums, teeth, and surrounding bone.
Gingivitis (Figure 5-20F) occurs as a result of accumulation of dental
plaque and dental calculus or tartar (a yellow-brown calcified deposit on
teeth). In gingivectomy, the periodontist uses a metal instrument to
scrape away plaque and tartar from teeth; any pockets of pus (pyorrhea)
are then drained and removed to allow new tissue to form. Localized
infections are treated with systemic antibiotics.
Upper Gastrointestinal Tract
FIGURE 5-21 A, Esophageal varices. B, Endoscopic view of
esophageal varices.
315
FIGURE 5-22 Hernias. A, Hiatal hernia. B, Inguinal hernias.
A direct inguinal hernia occurs through the abdominal wall in an
area of muscular weakness. An indirect inguinal hernia occurs
through the inguinal canal (passageway in the lower abdomen),
where the herniated tissue/bowel descends into the scrotal sac.
316
achalasia
esophageal
cancer
esophageal
varices
gastric cancer
gastroesophageal
reflux disease
(GERD)
hernia
peptic ulcer
Failure of the lower esophagus sphincter (LES) muscle to relax.
Achalasia (-chalasia = relaxation) results from the loss of peristalsis
so that food cannot pass easily through the esophagus. Both failure
of the LES to relax and the loss of peristalsis cause dilatation
(widening) of the esophagus above the constriction. Physicians
recommend a bland diet low in bulk and mechanical stretching of
the LES to relieve symptoms.
Malignant tumor of the esophagus.
The most common symptom of esophageal cancer is difficulty
swallowing (dysphagia). Smoking and chronic alcohol use are major
risk factors. Long-term irritation of the esophagus caused by gastric
reflux is a premalignant condition called Barre esophagus.
Surgery, radiation therapy, and chemotherapy are treatment
options.
Swollen varicose veins at the lower end of the esophagus (Figure
5-21).
Liver disease (such as cirrhosis and chronic hepatitis) causes
increased pressure in veins near and around the liver (portal
hypertension). This leads to enlarged, tortuous esophageal veins
with danger of hemorrhage (bleeding). Treatment may include
banding (tying off the swollen esophageal veins) or sclerotherapy
(injecting veins with a solution that closes them). Drug therapy to
lower portal hypertension can be used to decrease the risk of
variceal bleeding.
Malignant tumor of the stomach.
Smoking, alcohol use, and chronic gastritis associated with bacterial
infection are major risk factors for gastric carcinoma. Gastric
endoscopy and biopsy diagnose the condition. Cure depends on
early detection and surgical removal.
Solids and fluids return to the mouth from the stomach.
Heartburn is a burning sensation caused by regurgitation of
hydrochloric acid from the stomach to the esophagus. Chronic
exposure of esophageal mucosa to gastric acid and pepsin (an
enzyme that digests protein) leads to reflux esophagitis. Drug
treatment for GERD includes antacid (acid-suppressive) agents and
medication to increase the tone of the LES.
Protrusion of an organ or part through the tissues and muscles
normally containing it.
A hiatal hernia occurs when the upper part of the stomach
protrudes upward through the diaphragm (Figure 5-22A). This
condition can lead to GERD. An inguinal hernia occurs when a
small loop of bowel protrudes through a weak lower abdominal
wall tissue (fascia) surrounding muscles (Figure 5-22B). Surgical
repair of inguinal hernias is known as herniorrhaphy (-rrhaphy
means suture).
Open sore in the lining of the stomach or duodenum.
A bacterium, Helicobacter pylori (H. pylori), is responsible for many
cases of peptic ulcer disease. The combination of bacteria,
hyperacidity, and gastric juice damages epithelial linings. Drug
treatment includes antibiotics, antacids, and agents to protect the
lining of the stomach and intestine.
317
Lower Gastrointestinal Tract (Small and Large
Intestines)
FIGURE 5-23 Anal fistula and colonic polyps. A, Anal fistula
and two types of polyps. B, Multiple polyps of the colon.
FIGURE 5-24 Adenocarcinoma of the colon. This tumor has
“heaped-up” edges and an ulcerated central portion.
318
FIGURE 5-25 A, Diverticula (resulting in diverticulosis) form
when the mucous membrane lining of the colon bulges through
the weakened muscular wall. B and C, Diverticulitis can result
when fecal material lodges in diverticula. Avoidance of foods with
seeds and nuts decreases the risk of this condition.
FIGURE 5-26 Intussusception and volvulus.
319
anal fistula
colonic polyps
colorectal
cancer
Crohn disease
(“Crohn's”)
diverticulosis
dysentery
hemorrhoids
ileus
inflammatory
bowel disease
(IBD)
intussusception
Abnormal tube-like passageway near the anus.
The fistula often results from a break or fissure in the wall of the anus
or rectum, or from an abscess (infected area) there (Figure 5-23A).
Polyps (benign growths) protrude from the mucous membrane of
the colon.
Figure 5-23A illustrates two types of polyps: pedunculated (a ached
to the membrane by a stalk) and sessile (si ing directly on the
mucous membrane). Figure 5-23B shows multiple polyps of the colon.
Many polyps are premalignant (adenomatous polyps); these growths
often are removed (polypectomy) as a preventative measure and for
further examination (biopsy).
Adenocarcinoma of the colon or rectum, or both.
Colorectal cancer (Figure 5-24) can arise from polyps in the colon or
rectal region. Diagnosis is determined by detecting blood in stool and
by colonoscopy. Prognosis depends on the stage (extent of spread) of
the tumor, including size, depth of invasion, and involvement of
lymph nodes. Surgical treatment may require excision of a major
section of colon with rejoining of the cut ends (anastomosis).
Chemotherapy and radiotherapy are administered as needed.
Chronic inflammation of the intestinal tract.
Crohn's can occur anywhere from mouth to anus but most commonly
in the ileum (ileitis) and colon. Signs and symptoms include diarrhea,
severe abdominal pain, fever, anorexia, weakness, and weight loss.
Both Crohn disease and ulcerative colitis are forms of inflammatory
bowel disease (IBD). Treatment is with drugs that control
inflammation and other symptoms or by surgical removal of diseased
portions of the intestine, with anastomosis of remaining parts. Read
the In Person: Living with Crohn's story on page 162.
Abnormal outpouchings (diverticula) in the intestinal wall of the
colon. See Figure 5-25A.
Diverticulitis is a complication of diverticulosis. When fecal ma er
becomes trapped in diverticula, diverticulitis can occur. Pain and
rectal bleeding are symptoms. Figure 5-25B and C shows diverticulitis
in a section through the sigmoid colon. Initial treatment for an a ack
of diverticulitis includes a liquid diet and oral antibiotics. In severe
cases, the patient may need hospitalization, intravenous antibiotics,
and surgery to remove the affected area of the colon with anastomosis
of the cut ends.
Painful inflammation of the intestines commonly caused by
bacterial infection.
Often occurring in the colon, dysentery results from ingestion of food
or water containing bacteria (salmonellae or shigellae), amebae (onecelled organisms), or viruses. Symptoms are bloody stools, abdominal
pain, and sometimes fever.
Swollen, twisted varicose veins in the rectal region.
Varicose veins can be internal (within the rectum) or external (outside
the anal sphincter). Pregnancy and chronic constipation, which put
pressure on anal veins, often cause hemorrhoids.
Loss of peristalsis with resulting obstruction of the intestines.
Surgery, trauma, or bacterial injury to the peritoneum can lead to a
paralytic ileus (acute, transient loss of peristalsis).
Inflammation of the colon and small intestine. See Crohn disease and
ulcerative colitis.
Telescoping of the intestines.
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irritable bowel
syndrome (IBS)
ulcerative
colitis
volvulus
In this condition, one segment of the bowel collapses into the opening
of another segment (Figure 5-26). It often occurs in children and at the
ileocecal region. Intestinal obstruction with pain and vomiting can
occur. A barium enema can diagnose and may successfully reduce the
intussusception. Otherwise, surgery to remove the affected segment
of bowel (followed by anastomosis) may be necessary.
Group of GI symptoms (abdominal pain, bloating, diarrhea,
constipation) without structural abnormalities in the intestines.
IBS may be associated with stress or occur after infection. Treatment
includes a diet high in bran and fiber and laxatives plus antidiarrheals
to establish regular bowel movements. Other names for IBS are
irritable colon and spastic colon. IBS is a type of functional
gastrointestinal disorder (FGID). These are disorders of how the
gastrointestinal tract functions, but without structural or biochemical
abnormalities. A diet low in FODMAPs (an acronym for
carbohydrates that are poorly absorbed by the intestine) has been
helpful in improving symptoms for many with IBS.
Chronic inflammation of the colon with presence of ulcers.
This idiopathic, chronic, recurrent diarrheal disease (an inflammatory
bowel disease) manifests with rectal bleeding and pain. Often
beginning in the colon, the inflammation spreads proximally,
involving the entire colon. Drug treatment and careful a ention to
diet are recommended. Resection of diseased bowel with ileostomy
may be necessary. In some cases it is cured by total colectomy.
Patients with ulcerative colitis are at a higher risk for developing
colon cancer.
Twisting of the intestine on itself.
Volvulus causes intestinal obstruction. Severe pain, nausea and
vomiting, and absence of bowel sounds are clinical features. Surgical
correction is necessary to prevent necrosis of the affected segment of
the bowel (see Figure 5-26).
Irritable Bowel Syndrome (IBS) and
Inflammatory Bowel Disease (IBD)
While IBS is a condition with no structural abnormalities of the
intestines, IBD (Crohn's and ulcerative colitis) involves structural
abnormalities.
Liver, Gallbladder, and Pancreas
321
FIGURE 5-27 Gallstone positions in the gallbladder and bile
ducts. A, Stone in the gallbladder causing mild or no symptoms.
B, Stone obstructing the cystic duct, causing pain. C, Stone
obstructing the common bile duct, causing pain and jaundice. D,
Stone at the lower end of the common bile duct and pancreatic
duct, causing pain, jaundice, and pancreatitis.
322
FIGURE 5-28 A, Trocars in place for laparoscopic
cholecystectomy. Trocars are used to puncture and enter the
abdomen. These devices are metal sleeves consisting of a
hollow metal tube (cannula) into which fits an obturator (a solid,
removable metal instrument with a sharp, three-cornered tip)
used to puncture the wall. Circled numbers show common
positions for trocar insertion: 1 is an umbilical 10/11-mm trocar
(the largest trocar diameter is 15). 2 is a 10/11-mm trocar at the
midline. 3 and 4 are 5-mm trocars placed in the right upper
quadrant of the abdomen. B, Gallstones. Mechanical
manipulation during laparoscopic cholecystectomy has caused
fragmentation of several cholesterol gallstones, revealing
interiors that are pigmented because of entrapped bile pigments.
The gallbladder mucosa is reddened and irregular as a result.
323
FIGURE 5-29 A, Normal liver. B, Liver with alcoholic cirrhosis.
324
cholelithiasis
cirrhosis
hepatocellular
carcinoma
(HCC)
pancreatic
cancer
pancreatitis
viral hepatitis
Gallstones in the gallbladder.
Calculi (stones) prevent bile from leaving the gallbladder and bile
ducts (Figure 5-27). Many patients remain asymptomatic and do not
require treatment; symptoms related to gallbladder stones are either
biliary colic (pain from blocked ducts) or cholecystitis (inflammation
and infection of the gallbladder), both of which require treatment.
Currently, laparoscopic or minimally invasive surgery (laparoscopic
cholecystectomy) can be performed to remove the gallbladder and
stones (Figure 5-28A and B).
Chronic degenerative disease of the liver.
Cirrhosis is commonly the result of chronic alcoholism, viral hepatitis,
iron overload, or other causes. Lobes of the liver become scarred with
fibrous tissue, hepatic cells degenerate, and the liver is infiltrated with
fat. Cirrh/o means yellow-orange, which describes the liver's color
caused by fat accumulation. Figure 5-29 shows a normal liver and a
liver with alcoholic cirrhosis.
Liver cancer.
Cancer that starts in the liver is primary liver cancer (as opposed to
secondary liver cancer, which starts in another organ and metastasizes
to the liver). HCC is commonly associated with hepatitis B and C virus
infections and cirrhosis due to chronic alcohol use. Nonalcoholic
steatohepatitis (NASH) is fa y infiltration of the liver, which may
progress to cirrhosis and HCC.
Surgery, radiation, and chemotherapy are therapeutic options.
Hepatocellular carcinomas produce alpha-fetoprotein (AFP), a tumor
marker that is often elevated in the blood in patients with this cancer.
AFP is used as a screen for HCC in patients with cirrhosis.
Liver cancers that begin in the bile ducts are called
cholangiocarcinomas. Bile duct cancers also can arise from the
gallbladder.
Malignant tumor of the pancreas.
It often occurs in the head of the pancreas (closer to the duodenum),
where it can block ducts. Although the cause is unknown, pancreatic
cancer is more common in smokers and people with diabetes and
chronic pancreatitis. Symptoms and signs are abdominal or back pain,
fatigue, jaundice, anorexia, diarrhea, and weight loss. The standard
surgical treatment, if the tumor can be resected, is a
pancreatoduodenectomy (Whipple procedure). Chemotherapy and
radiation may also be used.
Inflammation of the pancreas.
Digestive enzymes a ack pancreatic tissue and damage the gland.
Other etiologic factors include chronic alcoholism, drug toxicity,
gallstone obstruction of the common bile duct, and viral infections.
Treatment includes medications to relieve epigastric pain, intravenous
fluids, bowel rest, and subtotal pancreatectomy if necessary.
Inflammation of the liver caused by a virus.
Hepatitis A is viral hepatitis caused by the hepatitis A virus (HAV). It
is a disorder spread by contaminated food or water and characterized
by slow onset of symptoms. Hepatitis B is caused by the hepatitis B
virus (HBV) and is transmi ed by sexual contact, blood transfusions,
or the use of contaminated needles or may be acquired by maternal to
fetal transmission. Severe infection can cause destruction of liver cells,
cirrhosis, or death. A vaccine that provides immunity is available and
recommended for persons at risk for exposure. Hepatitis C is caused
by the hepatitis C virus (HCV) and is transmi ed by blood transfusions
325
or needle inoculation (such as among intravenous drug users sharing
needles). The acute illness may progress to chronic hepatitis and
hepatocellular carcinoma. Two drugs recently approved by the FDA for
hepatitis C are Mavyret and Vosevi.
In all types, liver enzyme levels may be elevated, indicating damage to
liver cells. Signs and symptoms include malaise, anorexia,
hepatomegaly, jaundice, and abdominal pain.
What's “in” Gallstones?
Gallstones are composed of cholesterol, bilirubin (pigment in bile), and
calcium salts. They can vary in size and shape—ranging from as small
as a grain of sand to as large as a golf ball!
Whipple Procedure for Pancreatic Cancer
This surgery consists of:
• removal of the distal half of the stomach (antrectomy)
• removal of gallbladder and common bile duct (cholecystectomy
and choledochectomy)
• removal of part of the pancreas and duodenum
(pancreatoduodenectomy)
• reconstruction consists of pancreatojejunostomy,
hepaticojejunostomy, and gastrojejunostomy
Steve Jobs, cofounder of Apple Inc., and Luciano Pavaro i, opera
singer, had this surgery.
In Person
Living with Crohn's
326
When a friend told me she was sick with the flu yesterday, I was
jealous. To someone with a chronic illness, like me, having something
acute always seems luxurious. Lie in bed, read glossy magazines, take
over-the-counter meds, sleep it off, and in a ma er of days you're okay.
I have Crohn disease, a chronic inflammation of the small intestine,
which is characterized by flare-ups and remission. During flare-ups,
I've experienced fever, diarrhea, vomiting, pain, and intestinal
obstruction. Even in remission I am never “okay.”
Right now I have been in remission two years after a third surgery to
remove yet another portion of my small bowel. This time internal
bleeding, a rather rare symptom of Crohn's, necessitated the surgery. I
was enduring weekly iron infusions, which turned into bimonthly
blood transfusions, as my hemoglobin plummeted to 6 (12 is normal). It
was no way to live. After the surgery, the bleeding stopped, but I had
bouts of urgent, watery diarrhea for a year. That was no way to live
either, and unfortunately, as wonderful as my doctor is, I've found that
few gastroenterologists want to address aftereffects of small bowel
surgery. After visiting several doctors and by trial and error, I finally
got these symptoms under control with codeine, Lomotil, and
Metamucil, but I will never be able to absorb vitamin B12, so I must
inject it monthly for the rest of my life. In addition to taking medicine
to cope with having less and less small bowel, I take medicine in the
hopes of preventing the next flare-up. Every few weeks, I inject myself
with a biologic medicine, Humira, but I must eventually be weaned off
this drug because it has possible long-term side effects, the scariest of
which is lymphoma. At 52 and with two school-age children, however,
I have learned to think of valuing my present quality of life the most,
over possible unknown dangers lurking in the future.
I do often think about the past. What would my life be like if our
family doctor hadn't told my parents that my constant episodes of
diarrhea—which occurred since I was a child—were caused by
“nerves?” By the time I was 21, my weight had dropped below 100
pounds, and I was twisted in pain after every meal. My dad arranged
for me to visit his own doctor, who gave me a small bowel series that
327
showed I had Crohn's and that a portion of my small intestine was “as
narrow as a pencil.” By then it was too late for even prednisone (then
the drug of choice despite side effects ranging from puffy face to
psychosis) to open up the inflamed passage, and I had my first surgery
just months after I was diagnosed. Thinking of those times—as well as
all the other flare-up times—makes me flinch. While you can never
relive pain, you can remember what it felt like. In my case, it was as if a
large metal bike lock chain was being forced through my tender gut.
Before that first surgery, I was just out of college and longing to make
my mark on the world, but I spent most of my evenings curled up in
my small bedroom, listening to the soothing strains of “Make Believe
Ballroom Hour” on the radio. Or, because vomiting and diarrhea
usually accompanied the pain, I lay with my back pressed against the
cold tiles of the bathroom floor. Later on, as a mom with two young
children, I would lie on the couch watching life swirl around me,
feeling guilty that I could not take part.
There was a silver lining to those flare-ups, and that is the tender
affection of those around me: husband, family, and friends. When you
have Crohn's, no one knows you have it until things get unbearable. It's
not the kind of illness you discuss, but when you have pain and fever,
you can kind of approximate those times of being felled by the flu. Yet
you know that it will take more than a dose of Nyquil or a night's sleep
to get “be er.” You know you'll face another course of medications—
often untried ones—or that you will likely end up in the hospital
undergoing yet another surgery.
Nancy J. Brandwein is a writer, editor, and food columnist.
328
Exercises
Remember to check your answers carefully with the Answers to
Exercises, pages 171–172.
A Match the following digestive system structures
with their meanings below.
anus
cecum
colon
duodenum
esophagus
gallbladder
ileum
jejunum
liver
pancreas
pharynx
sigmoid colon
1. consists of ascending, transverse, descending, and
sigmoid sections __________________________
2. small sac under the liver; stores bile
_________________
3. first part of the large intestine _________________
4. end of the digestive tract opening to the outside of
the body _________________
5. second part of the small intestine
_________________
6. tube connecting the throat to the stomach
_________________
7. third part of the small intestine _________________
329
p
8. large organ in the RUQ; secretes bile, stores sugar,
produces blood proteins _________________
9. throat _________________
10. lowest part of the colon _________________
11. first part of the small intestine _________________
12. organ under the stomach; produces insulin and
digestive enzymes _________________
B Label the following flow chart of the pathway of
food through the gastrointestinal tract. The terms
you will need are listed below:
anus
ascending colon
cecum
descending colon
duodenum
esophagus
gallbladder
ileum
jejunum
liver
pancreas
pharynx
rectum
salivary glands
sigmoid colon
stomach
transverse colon
330
C Circle the bold term that fits the given definition.
You should be able to define the other terms as
well!
1. microscopic projections in the walls of the small
intestine:
331
papillae villi rugae
2. salivary gland near the ear:
submandibular sublingual parotid
3. ring of muscle at the end of the stomach:
pyloric sphincter uvula lower esophageal
sphincter
4. soft, inner section of a tooth:
dentin enamel pulp
5. chemical that speeds up reactions and helps digest
foods:
triglyceride amino acid enzyme
6. pigment released with bile:
glycogen bilirubin melena
7. hormone produced by endocrine cells of the
pancreas:
insulin amylase lipase
8. rhythm-like contraction of the muscles in the walls
of the gastrointestinal tract:
deglutition mastication peristalsis
9. breakdown of large fat globules:
absorption emulsification anabolism
10. pointed, dog-like tooth medial to premolars:
incisor canine molar
D Complete the following.
1. Labi/o and cheil/o mean
_____________________________________________
_________________
2. Gloss/o and lingu/o mean _________________
332
3. Or/o and stomat/o mean _________________
4. Dent/i and odont/o mean _________________
5. Lapar/o and celi/o mean _________________
6. Gluc/o and glyc/o mean _________________
7. Lip/o, steat/o, and adip/o mean _________________
8. The suffixes -iasis and -osis mean
_________________
9. Chol/e and bil/i mean _________________
10. Resection and -ectomy mean _________________
E Build medical terms based on the given definitions.
1. removal of a salivary gland
_____________________________________________
______________
2. pertaining to the throat _________________
3. hernia of the rectum _________________
4. enlargement of the liver _________________
5. surgical repair of the roof of the mouth
_________________
6. after meals _________________
7. visual examination of the anal and rectal region
_________________
8. study of the cause (of disease) _________________
9. incision of the common bile duct
_________________
10. pertaining to teeth and cheek _________________
11. disease condition of the small intestine
_________________
12. new opening between the common bile duct and
the jejunum _________________
333
13. pertaining to surrounding the anus
_________________
14. new opening from the colon to the outside of the
body _________________
15. under the lower jaw _________________
16. pertaining to the face _________________
F Match the following doctors or dentists with their
specialties.
colorectal surgeon
endodontist
gastroenterologist
nephrologist
oral surgeon
orthodontist
periodontist
proctologist
urologist
1. treats disorders of the anus and rectum
____________________________
2. operates on the organs of the urinary tract
_________________
3. straightens teeth _________________
4. performs root canal therapy _________________
5. operates on the mouth and teeth
_________________
6. treats kidney disorders _________________
7. diagnoses and treats gastrointestinal disorders
_________________
334
8. treats gum disease _________________
9. operates on the intestinal tract _________________
G Build medical terms to describe the following
inflammations.
1. inflammation of the appendix _________________
2. inflammation of the large intestine
_________________
3. inflammation of the passageway from the throat to
the stomach _________________
4. inflammation of the membrane surrounding the
abdomen _________________
5. inflammation of the gallbladder _________________
6. inflammation of the third part of the small intestine
_________________
7. inflammation of the pancreas _________________
8. inflammation of the gums _________________
9. inflammation of the liver _________________
10. inflammation of the mouth _________________
11. inflammation of the salivary gland
_________________
12. inflammation of the small and large intestines
_________________
H Match the listed terms with the meanings that
follow.
anastomosis
biliary
defecation
cheilitis
335
gluconeogenesis
glycogenolysis
hyperbilirubinemia
hyperglycemia
mesentery
mucosa
parenteral
portal vein
1. high level of blood sugar
______________________________
2. inflammation of the lip _________________
3. pertaining to administration of medicines and fluid
other than by mouth _________________
4. mucous membrane _________________
5. expulsion of feces from the body through the anus
_________________
6. breakdown (conversion) of starch to sugar
_________________
7. fan-like membrane that connects the small intestine
to the abdominal wall _________________
8. large vessel that takes blood to the liver from the
intestines _________________
9. new surgical connection between structures or
organs _________________
10. pertaining to bile ducts _________________
11. process of forming new sugar from proteins and
fats _________________
12. high levels of a bile pigment in the bloodstream
_________________
336
I Give the names of the following gastrointestinal
signs or symptoms based on their descriptions.
1. passage of bright red blood from the rectum
___________________________________
2. lack of appetite _________________
3. fat in the feces _________________
4. black, tarry stools; feces containing digested blood
_________________
5. abnormal accumulation of fluid in the abdomen
_________________
6. rumbling noises produced by gas in the
gastrointestinal tract _________________
7. gas expelled through the anus _________________
8. an unpleasant sensation in the stomach and a
tendency to vomit _________________
9. loose, watery stools _________________
10. difficulty in passing stools (feces)
_________________
11. difficulty in swallowing _________________
12. gas expelled from the stomach through the mouth
_________________
J Write short answers for the following questions.
1. What is jaundice?
_____________________________________________
_____________________
2. List three ways in which a patient can become
jaundiced:
a.
___________________________________________
____
337
b.
___________________________________________
____
c.
___________________________________________
____
3. What does it mean when a disease is described as
idiopathic? ________________________________
K Select from the list of pathologic conditions to make
a diagnosis.
achalasia
anal fistula
aphthous stomatitis
colonic polyps
colorectal cancer
Crohn disease (Crohn's)
dental caries
esophageal cancer
herpetic stomatitis
oral leukoplakia
pancreatic cancer
periodontal disease
1. Mr. Jones, a smoker and heavy drinker,
complained of dysphagia in recent months. A
longstanding condition of Barre esophagus
resulted in his malignant condition. Diagnosis:
_______________________________.
2. An abnormal tube-like passageway near his anus
caused Mr. Rosen's proctalgia. His doctor
338
performed surgery to close off the abnormality.
Diagnosis: _______________________________.
3. Carol's dentist informed her that the enamel of
three teeth was damaged by bacteria-producing
acid. Diagnosis:
_______________________________.
4. Paola's symptoms of chronic diarrhea, abdominal
cramps, and fever led her doctor to suspect that
she suffered from an inflammatory bowel disease
affecting the distal portion of her ileum. The doctor
prescribed steroid drugs to heal her condition.
Diagnosis: _______________________________.
5. Mr. Hart learned that his colonoscopy showed the
presence of small benign growths protruding from
the mucous membrane of his large intestine.
Diagnosis: ____________________________.
6. During a routine dental checkup, Dr. Friedman
discovered white plaques on Mr. Longo's buccal
mucosa. He advised Mr. Longo, who was a chronic
smoker and heavy drinker, to have these
precancerous lesions removed. Diagnosis:
_______________________________.
7. Every time Carl had a stressful time at work, he
developed a fever blister (cold sore) on his lip,
resulting from reactivation of a previous viral
infection. His doctor told him that there was no
treatment 100% effective in preventing the
reappearance of these lesions. Diagnosis:
_______________________________.
8. Mr. Green had a biopsy of a neoplastic lesion in his
descending colon. The pathology report indicated
339
a malignancy. A partial colectomy was necessary.
Diagnosis: _______________________________.
9. Small ulcers (canker sores) appeared on Diane's
gums. They were painful and annoying. Diagnosis:
_______________________________.
10. Sharon's failure to floss her teeth and remove
dental plaque regularly led to development of
gingivitis and pyorrhea. Her dentist advised
consulting a specialist who could treat her
condition. Diagnosis:
_______________________________.
11. Imaging tests revealed a tumor in a section of Mr.
Smith's pancreas. His physician told him that since
it had not spread, he could hope for a cure with
surgery. He had a pancreatoduodenectomy
(Whipple procedure), which was successful.
Diagnosis: _______________________________.
12. Mr. Clark complained of pain during swallowing.
His physician explained that the pain was caused
by a failure of muscles in his lower esophagus to
relax during swallowing. Diagnosis:
_______________________________.
L Match the following pathologic diagnoses with their
definitions.
cholecystolithiasis (gallstones)
cirrhosis
diverticulosis
dysentery
esophageal varices
hemorrhoids
340
hiatal hernia
ileus
intussusception
irritable bowel syndrome
pancreatitis
peptic ulcer
ulcerative colitis
viral hepatitis
volvulus
1. protrusion of the upper part of the stomach
through the diaphragm
___________________________
2. painful, inflamed intestines caused by bacterial
infection _________________
3. swollen, twisted veins in the rectal region
_________________
4. open sore or lesion of the mucous membrane of the
stomach or duodenum _________________
5. loss of peristalsis _________________
6. twisting of the intestine on itself
_________________
7. swollen, varicose veins on the surface of the distal
portion of the esophagus _________________
8. abnormal outpouchings in the intestinal wall
_________________
9. chronic inflammation of the colon with destruction
of its inner surface _________________
10. telescoping of the intestines _________________
341
11. inflammation of the liver caused by type A, type
B, or type C virus _________________
12. inflammation of the pancreas _________________
13. calculi in the sac that stores bile
_________________
14. chronic degenerative liver disease with scarring
resulting from alcoholism or infectious hepatitis
_________________
15. gastrointestinal symptoms (diarrhea or
constipation, abdominal pain, bloating) with no
evidence of structural abnormalities
_________________
M Complete the following terms from their meanings
given below.
1. membrane (peritoneal fold) that holds the
intestines together: mes _______________________
2. removal of the gallbladder:
_______________________ ectomy
3. black or dark brown, tarry stools containing blood:
mel _______________________
4. high levels of pigment in the blood (jaundice):
hyper _______________________
5. pertaining to under the tongue: sub
_______________________
6. twisting of the intestine on itself: vol
_______________________
7. organ under the stomach that produces insulin and
digestive enzymes: pan _________________
8. lack of appetite: an _______________________
342
9. swollen, twisted veins in the rectal region:
_______________________ oids
10. new connection between two previously
unconnected tubes: ana _______________________
11. absence of acid in the stomach: a
_______________________
12. return of solids and fluids to the mouth from the
stomach: gastro re _______________________
disease
13. removal of soft tissue hanging from the roof of the
mouth: _______________________ ectomy
14. formation of stones: _______________________
genesis.
343
Answers to Exercises
A
1. colon
2. gallbladder
3. cecum
4. anus
5. jejunum
6. esophagus
7. ileum
8. liver
9. pharynx
10. sigmoid colon
11. duodenum
12. pancreas
B
See Figure 5-12 on page 141.
C
1. Villi. Papillae are nipple-like projections in the tongue
where taste buds are located, and rugae are folds in
the mucous membrane of the stomach and hard
palate.
2. Parotid. The submandibular gland is under the lower
jaw, and the sublingual gland is under the tongue.
344
3. Pyloric sphincter. The uvula is soft tissue hanging
from the soft palate, and the lower esophageal
sphincter is a ring of muscle between the esophagus
and stomach.
4. Pulp. Dentin is the hard part of the tooth directly
under the enamel and in the root, and enamel is the
hard, outermost part of the tooth composing the
crown.
5. Enzyme. A triglyceride is a large fat molecule, and an
amino acid is a substance produced when proteins
are digested.
6. Bilirubin. Glycogen is animal starch that is produced
in liver cells from sugar, and melena is dark, tarry
stools.
7. Insulin. Amylase and lipase are digestive enzymes
produced by the exocrine cells of the pancreas.
8. Peristalsis. Deglutition is swallowing, and
mastication is chewing.
9. Emulsification. Absorption is the passage of materials
through the walls of the small intestine into the
bloodstream, and anabolism is the process of
building up proteins in a cell (protein synthesis).
10. Canine. An incisor is one of the four front teeth in
the dental arch (not pointed or like a dog's tooth),
and a molar is any of three large teeth just behind
(distal to) the two premolar teeth.
D
1. lip
345
2. tongue
3. mouth
4. tooth
5. abdomen
6. sugar
7. fat
8. abnormal condition
9. gall, bile
10. removal, excision
E
1. sialadenectomy
2. pharyngeal
3. rectocele
4. hepatomegaly
5. palatoplasty
6. postprandial (post cibum—cib/o refers to meals or
feeding)
7. proctoscopy
8. etiology
9. choledochotomy
10. dentibuccal
11. enteropathy
12. choledochojejunostomy
346
13. perianal
14. colostomy
15. submandibular
16. facial
F
1. proctologist
2. urologist
3. orthodontist
4. endodontist
5. oral surgeon
6. nephrologist
7. gastroenterologist
8. periodontist
9. colorectal surgeon
G
1. appendicitis
2. colitis
3. esophagitis
4. peritonitis (note that the e is dropped)
5. cholecystitis
6. ileitis
7. pancreatitis
8. gingivitis
347
9. hepatitis
10. stomatitis
11. sialadenitis
12. enterocolitis (when two combining forms for
gastrointestinal organs are in a term, use the one that
is closest to the mouth first)
H
1. hyperglycemia
2. cheilitis
3. parenteral
4. mucosa
5. defecation
6. glycogenolysis
7. mesentery
8. portal vein
9. anastomosis
10. biliary
11. gluconeogenesis
12. hyperbilirubinemia
I
1. hematochezia
2. anorexia
3. steatorrhea
348
4. melena
5. ascites
6. borborygmi (bowel sounds)
7. flatus
8. nausea
9. diarrhea
10. constipation
11. dysphagia
12. eructation
J
1. yellow-orange coloration of the skin and other tissues
(hyperbilirubinemia)
2. a. any liver disease (hepatopathy—such as cirrhosis,
hepatoma, or hepatitis), so that bilirubin is not
processed into bile and cannot be excreted in feces
b. obstruction of bile flow, so that bile and bilirubin
are not excreted and accumulate in the
bloodstream
c. excessive hemolysis leading to overproduction of
bilirubin and high levels in the bloodstream
3. cause is not known
K
1. esophageal cancer
2. anal fistula
3. dental caries
349
4. Crohn disease (Crohn's)
5. colonic polyps
6. oral leukoplakia
7. herpetic stomatitis
8. colorectal cancer
9. aphthous stomatitis
10. periodontal disease
11. pancreatic cancer
12. achalasia
L
1. hiatal hernia
2. dysentery
3. hemorrhoids
4. peptic ulcer
5. ileus
6. volvulus
7. esophageal varices
8. diverticulosis
9. ulcerative colitis
10. intussusception
11. viral hepatitis
12. pancreatitis
13. cholecystolithiasis (gallstones)
350
14. cirrhosis
15. irritable bowel syndrome
M
1. mesentery
2. cholecystectomy
3. melena
4. hyperbilirubinemia
5. sublingual
6. volvulus
7. pancreas
8. anorexia
9. hemorrhoids
10. anastomosis
11. achlorhydria
12. gastroesophageal reflux
13. uvulectomy
14. lithogenesis
Pronunciation of Terms
The terms you have learned in this chapter are presented here with
their pronunciations. The meanings for all the terms are in the MiniDictionary beginning on page 897. You can also hear each term
pronounced on the Evolve website
(h p://evolve.elsevier.com/Chabner/language/).
Vocabulary and Terminology
351
TERM
absorption
achlorhydria
amino acids
amylase
anastomosis
anus
appendectomy
appendicitis
appendixe
bile
biliary
bilirubin
bowel
buccal mucosa
canine teeth
cecal
cecum
celiac
cheilosis
cholecystectomy
choledochojejunostomy
choledocholithiasis
choledochotomy
cholelithiasis
colon
colonic
colonoscopy
colostomy
common bile duct
defecation
deglutition
dentibuccal
dentin
digestion
duodenal
duodenum
elimination
emulsification
enamel
endodontist
enterocolitis
enteroenterostomy
enzyme
esophageal
esophagus
facial
fa y acids
feces
gallbladder
gastrointestinal tract
gastrojejunostomy
gastrostomy
PRONUNCIATION
ab-SORP-shun
a-chlor-HI-dre-ah
ah-ME-no AS-idz
AM-ih-layz
ah-nas-to-MO-sis
A-nus
ah-pen-DEK-to-me
ah-pen-dih-SI-tis
ah-PEN-diks
bile
BIH-le-er-e
bih-le-RU-bin
BOW-el
BUK-al mu-KO-sah
KA-nine teeth
SE-kal
SE-kum
SE-le-ak
ki-LO-sis
ko-le-sis-TEK-to-me
ko-leh-do-ko-jeh-ju-NOS-to-me
ko-leh-do-ko-lih-THI-ah-sis
ko-leh-do-KOT-o-me
ko-le-lih-THI-ah-sis
KO-lon
ko-LON-ik
ko-lon-OS-ko-pe
ko-LOS-to-me
KOM-on bile dukt
deh-feh-KA-shun
de-glu-TIH-shun
den-tih-BUK-al
DEN-tin
di-JEST-shun
du-o-DE-nal
do-o-DE-num
e-lim-ih-NA-shun
e-mul-sih-fih-KA-shun
e-NAM-el
en-do-DON-tist
en-ter-o-ko-LI-tis
en-ter-o-en-ter-OS-to-me
EN-zime
eh-sof-ah-JE-al
eh-SOF-ah-gus
FA-shul
FAH-te AS-idz
FE-seez
GAWL-blah-der
gas-tro-in-TES-tih-nal trakt
gas-tro-jeh-ju-NOS-to-me
gas-TROS-to-me
352
TERM
gingivitis
gluconeogenesis
glucose
glycogen
glycogenolysis
hepatoma
hepatomegaly
hydrochloric acid
hyperbilirubinemia
hyperglycemia
hypoglossal
ileitis
ileocecal sphincter
ileostomy
ileum
incisor
insulin
jejunum
labial
laparoscopy
lipase
lithogenesis
liver
lower esophageal sphincter
mastication
melena
mesentery
molar teeth
oral
orthodontist
palate
palatopharyngoplasty
palatoplasty
pancreas
pancreatitis
papillae
parenteral
parotid gland
perianal
periodontist
peristalsis
peritonitis
pharyngeal
pharynx
portal vein
postprandial
premolar teeth
proctologist
protease
pulp
pyloric sphincter
pyloroplasty
PRONUNCIATION
jin-jih-VI-tis
glu-ko-ne-o-JEN-eh-sis
GLU-kohs
GLI-ko-jen
gli-ko-je-NOL-ih-sis
hep-ah-TO-mah
hep-ah-to-MEG-ah-le
hi-dro-KLOR-ik AS-id
hi-per-bih-le-ru-bih-NE-me-ah
hi-per-gli-SE-me-ah
hi-po-GLOS-al
il-e-I-tis
il-e-o-SE-kal SFINK-ter
il-e-OS-to-me
IL-e-um
in-SI-zor
IN-su-lin
je-JU-num
LA-be-al
lap-ah-ROS-ko-pe
LI-payz
lith-o-JEN-eh-sis
LIV-er
LO-er eh-sof-ah-JE-al SFINK-ter
mas-tih-KA-shun
MEL-en-ah
MES-en-ter-e
MO-lar teeth
OR-al
or-tho-DON-tist
PAH-lat
pah-lat-o-fah-RIN-go-plas-te
pah-LAT-o-plas-te
PAN-kre-as
pan-kre-ah-TI-tis
pap-IL-e
par-EN-ter-al
par-OT-id gland
peh-re-A-nal
peh-re-o-DON-tist
peh-rih-STAL-sis
peh-rih-to-NI-tis
fah-ran-JE-al
FAH-rinks
POR-tal vayn
post-PRAN-de-al
pre-MO-lar teeth
prok-TOL-o-jist
PRO-te-ayz
pulp
pi-LOR-ik SFINK-ter
pi-LOR-o-plas-te
353
TERM
pylorus
rectocele
rectum
rugae
saliva
salivary glands
sialadenitis
sialolith
sigmoid colon
sigmoidoscopy
sphincter
steatorrhea
stomach
stomatitis
sublingual
submandibular
triglycerides
uvula
uvulectomy
villi
PRONUNCIATION
pi-LOR-us
REK-to-seel
REK-tum
RU-guy
sah-LI-vah
SAH-lih-vah-re glandz
si-al-ah-deh-NI-tis
si-AL-o-lith
SIG-moyd KO-lon
sig-moyd-OS-ko-pe
SFINK-ter
ste-at-o-RE-ah
STUM-ak
sto-mah-TI-tis
sub-LING-wal
sub-man-DIH-bu-lar
tri-GLIS-eh-ridez
U-vu-lah
u-vu-LEK-to-me
VIL-i
Pathologic Terminology
354
TERM
achalasia
anal fistula
anorexia
aphthous stomatitis
ascites
borborygmi
cholelithiasis
cirrhosis
colonic polyps
colorectal cancer
constipation
Crohn disease
dental caries
diarrhea
diverticula
diverticulosis
dysentery
dysphagia
eructation
esophageal cancer
esophageal varices
etiology
flatus
gastric cancer
gastroesophageal reflux disease
hematochezia
hemorrhoids
hepatocellular carcinoma
herpetic stomatitis
hiatal hernia
icterus
idiopathic
ileus
inflammatory bowel disease
inguinal hernia
intussusception
irritable bowel syndrome
jaundice
lipoma
melena
nausea
oral leukoplakia
pancreatic cancer
pancreatitis
peptic ulcer
periodontal disease
pyorrhea
ulcerative colitis
viral hepatitis
volvulus
PRONUNCIATION
ak-ah-LA-jah
A-nal FIS-tu-la
an-or-EK-se-ah
AF-thus sto-mah-TI-tis
ah-SI-teez
bor-bor-IG-me
ko-le-lih-THI-ah-sis
sih-RO-sis
ko-LON-ik POL-ips
ko-lo-REK-tal KAN-ser
con-stih-PA-shun
KROHN dih-ZEEZ
DEN-tal KAH-reez
di-ah-RE-ah
di-ver-TIH-ku-lah
di-ver-tih-ku-LO-sis
DIS-en-ter-e
dis-PHA-je-ah
e-ruk-TA-shun
eh-sof-ah-JE-al KAN-ser
eh-sof-ah-JE-al VAR-ih-seez
e-te-OL-o-je
FLA-tus
GAS-trik KAN-ser
gas-tro-eh-sof-ah-JE-al RE-flux dih-ZEEZ
he-mah-to-KE-se-ah
HEH-mah-roydz
hep-at-o-SEL-u-lar kar-sih-NO-mah
her-PET-ik sto-mah-TI-tis
hi-A-tal HER-ne-ah
IK-ter-us
id-e-o-PATH-ik
IL-e-us
in-FLAM-ah-tor-e BOW-el dih-ZEEZ
IN-gwih-nal HER-ne-ah
in-tuh-suh-SEP-shun
IR-it-ah-bel BOW-el SIN-drohm
JAWN-dis
li-PO-mah
MEL-en-ah
NAW-ze-ah
OR-al lu-ko-PLA-ke-ah
pan-kre-AH-tik KAN-ser
pan-kre-ah-TI-tis
PEP-tic UL-ser
peh-re-o-DON-tal dih-ZEEZ
pi-or-RE-ah
UL-ser-ah-tiv ko-LI-tis
VI-ral hep-ah-TI-tis
VOL-vu-lus
355
Note: A combination Review Sheet for this chapter and the next one is
provided in Chapter 6 on page 201.
356
CHAPTER 6
357
Additional Suffixes and Digestive
System Terminology
CHAPTER SECTIONS:
Introduction 178
Suffixes 178
Terminology 181
Laboratory Tests and Clinical Procedures 183
Abbreviations 190
In Person: Cholecystectomy 191
Practical Applications 192
Exercises 192
Answers to Exercises 198
Pronunciation of Terms 199
Review Sheet 201
CHAPTER GOALS
• Define new suffixes and use them to form terms related to the digestive
system.
• List and explain laboratory tests, clinical procedures, and abbreviations
relevant to the digestive system.
• Apply your new knowledge to understanding medical terms in their proper
context, such as in medical reports and records and in personal
vignettes.
358
359
Introduction
This chapter gives you practice in word building, while not introducing
a large number of new terms. It uses many familiar terms from Chapter
5, which should give you a breather after your hard work.
Study the suffixes presented next and complete the meanings of the
terms. Checking the meanings of the terms with a dictionary may prove
helpful and add another dimension to your understanding.
The information included under Laboratory Tests and Clinical
Procedures and in the Abbreviations section relates to the
gastrointestinal system and will be useful for work in clinical or
laboratory medical se ings.
The Practical Applications section gives you examples of medical
language in context. Congratulate yourself as you decipher medical
sentences, operative reports, and case studies.
Suffixes
Write the meaning of the medical term in the space provided.
360
SUFFIX MEANING
-ectasis, dilation
-ectasia (dilatation),
widening
-emesis vomiting
TERMINOLOGY
MEANING
cholangiectasis _________________________________
Cholangi/o means bile duct (vessel). Bile duct obstruction may
cause cholangiectasis (ko-lan-je-EK-tah-sis).
hematemesis ___________________________________
Bright red blood is vomited, often associated with esophageal varices
or peptic ulcer.
-pepsia digestion
dyspepsia ___________________________________
-phagia eating,
polyphagia ___________________________________
swallowing
Excessive appetite and uncontrolled eating.
dysphagia ___________________________________
-plasty surgical repair
abdominoplasty _________________________________
This is commonly referred to as a “tummy tuck.” Other surgical
repairs are rhinoplasty and blepharoplasty.
-ptysis spi ing
hemoptysis _________________________________
(he-MOP-tih-sis) Spi ing up blood from the respiratory tract and
lungs.
-rrhage, bursting forth
hemorrhage ____________________________________
-rrhagia (of blood)
Loss of a large amount of blood in a short period.
gastrorrhagia ____________________________________
suture
herniorrhaphy ____________________________________
rrhaphy
(her-ne-OR-ah-fe) Repair (as in stitching or suturing) of a hernia.
Hernioplasty is a synonym.
-rrhea
flow,
diarrhea ____________________________________
discharge
The embedded root rrh means flow or discharge.
-spasm involuntary
pylorospasm ____________________________________
contraction of
bronchospasm ____________________________________
muscles
A chief characteristic of bronchitis and asthma.
-stasis stopping,
cholestasis ____________________________________
controlling
Flow of bile from the liver to the duodenum is interrupted.
narrowing,
pyloric stenosis ____________________________________
stenosis tightening
This is a congenital defect in newborns blocking the flow of food into
the small intestine.
-tresia opening
atresia ________________________________________
Absence of a normal opening.
esophageal atresia
________________________________________
A congenital anomaly in which the esophagus does not connect with
the stomach. A tracheoesophageal fistula often accompanies this
abnormality (Figure 6-1).
biliary atresia ________________________________________
Congenital hypoplasia or nonformation of bile ducts causes neonatal
cholestasis and jaundice.
361
FIGURE 6-1 Esophageal atresia with tracheoesophageal fistula.
-ectasis, -ectasia
These suffixes are commonly used in respiratory system terminology in
Chapter 12. Examples are bronchiectasis and atelectasis (a- = not, tel =
complete), which is a collapsed lung.
Dysphagia/Dysplasia/Dysphasia
Don't confuse dysphagia, which is difficulty in swallowing, with
dysplasia, which is abnormal formation (plas/o = formation), or
dysphasia, which is abnormal speech (phas/o = speech).
Hemoptysis and Hematemesis
Hemoptysis is spi ing up blood from the respiratory tract, a sign of
bleeding and disease within the bronchial tubes and lungs.
Hematemesis is vomiting blood, a sign of bleeding from the upper part
of the gastrointestinal tract.
362
-rrhea
The suffix -rrhea is used to indicate flow or discharge of various
substances:
• rhinorrhea-mucus from the nose
• menorrhea-menstrual (men/o) blood from the uterine lining
• leukorrhea-white, yellowish fluid from the vagina
Stenosis
Stenosis comes from the Greek meaning “narrowing.” It is sometimes
called a stricture. While this term is used in the gastrointestinal system
to describe narrowing, as in bowel obstruction, biliary tract stenosis,
and pyloric stenosis, there are other types of stenoses as well. These
include:
• arterial stenosis
• heart valve stenosis
• spinal stenosis
• tracheal stenosis
Examples of suffixes that are used alone as separate terms are:
emesis An emesis basin is a kidney-shaped container positioned beside a hospital bed to
(emetic) collect vomit. If a child swallows poison, the physician may prescribe a drug to
induce emesis. An emetic is a strong solution such as ipecac syrup administered
to induce vomiting after a patient swallows poison.
spasm Eating spicy foods can lead to spasm of gastric sphincters.
stasis
Overgrowth of bacteria within the small intestine can cause stasis of the intestinal
contents.
stenosis Projectile vomiting in an infant during feeding is a clinical sign of pyloric
stenosis.
Terminology
Write the meaning of the terms in the spaces provided.
363
COMBINING
MEANING
TERMINOLOGY
MEANING
FORM
bucc/o
______________ buccal ________________________________________
cec/o
______________ cecal volvulus
________________________________________
celi/o
______________
celiac disease
________________________________________
Damage to the lining of the small intestine occurring as a
reaction to eating gluten (protein found in wheat, barley,
and rye). Malabsorption and malnutrition result.
Treatment consists of a lifelong gluten-free diet. It also is
called celiac sprue.
cheil/o
______________
cheilosis ________________________________________
Characterized by scales and fissures on the lips and
resulting from a deficiency of vitamin B2 (thiamine) in the
diet.
chol/e
______________ cholelithiasis
________________________________________
cholangi/o
______________
cholangitis
________________________________________
In this term, one i is dropped. The most common cause of
this condition is bacterial infection.
cholangiocarcinoma
________________________________________
cholecyst/o
______________ cholecystectomy
________________________________________
choledoch/o
______________
choledochal
________________________________________
choledochectasia
________________________________________
col/o
______________
colectomy
________________________________________
Surgeons perform a LAP (laparoscopic) colectomy as an
alternative to open colectomy to remove nonmetastatic
colorectal carcinomas.
colon/o
______________ colonoscopy ________________________________________
dent/i
______________ dentalgia ________________________________________
duoden/o
______________ duodenal ________________________________________
enter/o
______________ gastroenteritis
________________________________________
esophag/o
______________
esophageal atresia
________________________________________
This congenital anomaly must be corrected surgically.
gastr/o
______________
gastrojejunostomy
________________________________________
gastrostomy
________________________________________
A gastrostomy is also called a G tube or “bu on.” One
type is a PEG (percutaneous endoscopic gastrostomy)
tube, which is inserted (laparoscopically) through the
abdomen into the stomach to deliver food and liquids when
swallowing is impossible.
gingiv/o
______________ gingivectomy
________________________________________
364
COMBINING
MEANING
TERMINOLOGY
MEANING
FORM
gloss/o
______________ glossectomy ________________________________________
gluc/o
______________ gluconeogenesis
________________________________________
glyc/o
______________
glycogen
________________________________________
A form of sugar stored in the liver.
hepat/o
______________ hepatomegaly
________________________________________
herni/o
______________ herniorrhaphy
________________________________________
ile/o
______________ ileostomy ________________________________________
jejun/o
______________ cholecystojejunostomy
________________________________________
labi/o
______________ labiodental ________________________________________
lingu/o
______________ sublingual ________________________________________
lip/o
______________ lipase ________________________________________
lith/o
______________ cholecystolithiasis
________________________________________
odont/o
______________ periodontal membrane
________________________________________
or/o
______________
oropharynx
________________________________________
The tonsils are located in the oropharynx.
palat/o
______________
palatoplasty
________________________________________
Also called palatorrhaphy; this procedure corrects cleft
(split) palate, a congenital anomaly.
pancreat/o
______________
pancreatic
________________________________________
pancreatoduodenectomy
________________________________________
Sometimes called a pancreaticoduodenectomy. This is a
Whipple procedure, a surgical treatment for pancreatic
cancer. See page 192.
proct/o
______________ proctosigmoidoscopy
________________________________________
pylor/o
______________ pyloric stenosis
________________________________________
rect/o
______________ rectal carcinoma
________________________________________
sialaden/o
______________ sialadenectomy
________________________________________
splen/o
______________
splenic flexure
________________________________________
The downward bend in the transverse colon near the spleen.
The hepatic flexure is the bend in the transverse colon
near the liver.
steat/o
______________ steatorrhea ________________________________________
stomat/o
______________ aphthous stomatitis
________________________________________
365
Laboratory Tests and Clinical
Procedures
Concentrate on learning the meanings in bold opposite the laboratory
test or procedure. Additional information is provided to increase your
understanding of terms.
Laboratory Tests
amylase
and lipase
tests
liver
function
tests
(LFTs)
stool
culture
stool
guaiac test
or
Hemoccult
test
Tests for the levels of amylase and lipase enzymes in the blood.
Increased levels are associated with pancreatitis.
Tests for the presence of enzymes and bilirubin in blood.
LFTs are performed on blood serum (clear fluid that remains after blood
has clo ed). Examples of LFTs are tests for ALT (alanine transaminase) and
AST (aspartate transaminase). ALT and AST are enzymes present in many
tissues. Levels are elevated in the serum of patients with liver disease.
High ALT and AST levels indicate damage to liver cells (as in hepatitis).
Alkaline phosphatase (alk phos) is another enzyme that may be elevated
in patients with liver, bone, and other diseases.
Serum bilirubin levels are elevated in patients with liver disease and
jaundice. A direct bilirubin test measures conjugated bilirubin. High
levels indicate liver disease or biliary obstruction. An indirect bilirubin
test measures unconjugated bilirubin. Increased levels suggest excessive
hemolysis, as may occur in a newborn.
Test for microorganisms present in feces.
Feces are placed in a growth medium and examined microscopically.
(Figure 6-2A).
Test to detect occult (hidden) blood in feces.
This is an important screening test for colon cancer. Guaiac (GWĪ-ăk) is a
chemical from the wood of trees. When added to a stool sample, it reacts
with any blood present in the feces. See Figure 6-2B.
366
FIGURE 6-2 A, Stool culture. B, Stool guaiac test.
Clinical Procedures
X-Ray Tests
X-ray imaging is used in many ways to detect pathologic conditions. In
dental practice, x-ray images are commonly used to locate cavities
(caries). Many of the x-ray tests listed here use a contrast medium
(substance that x-rays cannot penetrate) to visualize a specific area of
the digestive system. The contrast, because of its increased density
relative to body tissue, allows organs and parts to be distinguished from
one another on the film or screen.
367
lower
gastrointestinal
series (barium
enema)
upper
gastrointestinal
series
cholangiography
computed
tomography
(CT)
X-ray images of the colon and rectum obtained after injection of
barium into the rectum.
Radiologists inject barium (a contrast medium) by enema into the
rectum. Figure 6-3A shows a barium enema study of a colon with
diverticulosis.
X-ray images of the esophagus, stomach, and small intestine
obtained after administering barium by mouth.
Often performed immediately after an upper gastrointestinal series,
a small bowel follow-through study shows sequential x-ray
pictures of the small intestine as barium passes through (Figure 63B). A barium swallow is a study of the esophagus.
X-ray examination of the biliary system performed after injection
of contrast into the bile ducts.
In percutaneous transhepatic cholangiography, the contrast
medium is injected using a needle placed through the abdominal
wall into the biliary vessels of the liver. In endoscopic retrograde
cholangiopancreatography (ERCP) (Figure 6-4A), contrast medium
is administered through an oral catheter (tube) and then passes
through the esophagus, stomach, and duodenum and into bile ducts.
This procedure helps diagnose problems involving the bile ducts,
gallbladder, and pancreas.
A series of x-ray images are taken in multiple views (especially
cross section).
A CT scan uses a circular array of x-ray beams to produce the crosssectional image based on differences in tissue densities. Use of
contrast material allows visualization of organs and blood vessels
and highlights differences in blood flow between normal and
diseased tissues (Figure 6-4B and Figure 6-5A and B). Tomography
(tom/o means cu ing) produces a series of x-ray pictures showing
multiple views of an organ. An earlier name for a CT scan is “CAT
scan” (computerized axial tomography scan).
368
FIGURE 6-3 A, Barium enema. This x-ray image from a barium
enema study demonstrates diverticulosis. The arrowheads point
to the diverticula throughout the colon. Most patients with
diverticula are asymptomatic, but complications (diverticulitis,
perforated diverticulum, obstruction, or hemorrhage) may occur.
B, An x-ray image of a small bowel follow-through study
demonstrating the normal appearance of the jejunum (J) in the
upper left abdomen and of the ileum (I) in the right lower
abdomen. Notice the contrast material within the stomach (S)
and cecum (C).
369
FIGURE 6-4 A, Endoscopic retrograde
cholangiopancreatography (ERCP) showing
choledocholithiasis in a patient with biliary colic (pain). Multiple
stones are visible in the gallbladder and common bile duct. The
stones (arrows) are seen as filling defects in the contrastopacified gallbladder and duct. This patient was treated with
open (performed via laparotomy) cholecystectomy and
choledocholithotomy. B, Computed tomography scan with
contrast showing large “porcelain stone” in the gallbladder. The
patient was asymptomatic, but a therapeutic option with this type
of stone is removal of the gallbladder (using laparoscopy) to
prevent any future problems (such as cholecystitis or carcinoma
of the gallbladder). (B, Courtesy Radiology Department,
Massachusetts General Hospital, Boston.)
370
FIGURE 6-5 Computed tomography (CT) images of normal
and diseased liver. A, Normal liver. Contrast material has been
injected intravenously, making blood vessels appear bright. The
liver (L) and spleen (S) are the same density on this CT image.
B, Fatty liver. The radiodensity of the liver tissue is reduced
because of the large volume of fat contained in the tissue,
making it appear darker than normal. Excess fat can lead to
inflammation of the liver and cirrhosis.
Ultrasound Examinations
abdominal
ultrasonography
endoscopic
ultrasonography
(EUS)
Sound waves beamed into the abdomen produce an image of
abdominal viscera.
Ultrasonography is especially useful for examination of fluid-filled
structures such as the gallbladder.
Use of an endoscope combined with ultrasound to examine the
organs of the gastrointestinal tract.
An endoscope is inserted through the mouth or rectum, and
ultrasound images are obtained. This test is often used in assessing
esophageal, pancreatic, and rectal cancer.
Magnetic Resonance Imaging
magnetic
resonance
imaging
(MRI)
Magnetic waves produce images of organs and tissues in all three planes
of the body.
This technique does not use x-rays. It detects subtle differences in tissue
composition, water content, and blood vessel density and can show sites of
trauma, infection, or cancer. See Figure 6-6, which shows an MRI study of a
patient with rectosigmoid carcinoma and polyps in the rectum. CT scanning
would not have shown these lesions as clearly.
371
FIGURE 6-6 Rectal (MRI). A 68-year-old man presented with
rectal bleeding. MRI demonstrates (A) colonic adenocarcinoma
in the rectosigmoid area as well as (B) villous adenoma in the
rectum.
Nuclear Medicine Test
HIDA
scan
Radioactive imaging procedure that tracks the production and flow of bile
from the liver and gallbladder to the intestine.
HIDA stands for hepatobiliary iminodiacetic acid. Cholescintigraphy is
another name for this test, which determines if the gallbladder is functioning
properly.
Other Procedures
372
fecal transplant
bariatric surgery
gastrointestinal
endoscopy
laparoscopy
liver biopsy
nasogastric
intubation
paracentesis
(abdominocentesis)
Transfer of stool from a healthy donor into the gastrointestinal
tract of a recipient.
Extensive antibiotic use can wipe out normal colonic bacteria and
can lead to infection with C. difficile (harmful bacteria that cause
diarrhea and colitis). A fecal transplant restores normal stool
bacteria via colonoscopy.
Procedures used to achieve weight loss in people with severe
obesity.
One type of bariatric surgery is bariatric (bar/o = weight, iatr/o =
treatment) sleeve gastrectomy, removal of a large portion of the
stomach (Figure 6-7A). Another bariatric procedure is gastric
bypass. This surgery reduces the size of the stomach to a volume
of 2 tablespoons and bypasses much of the small intestine (Figure
6-7B).
Visual examination of the gastrointestinal tract using an
endoscope.
A physician places a flexible fiberoptic tube through the mouth or
the anus to view parts of the gastrointestinal tract. Examples are
esophagogastroduodenoscopy (EGD) (Figure 6-8), colonoscopy
(Figures 6-9 and 6-10), sigmoidoscopy, proctoscopy, and
anoscopy.
Virtual colonoscopy (CT colonography) combines CT scanning
and computer technology to enable physicians to examine the
entire length of the colon by x-ray imaging in just minutes.
Patients with abnormal findings require conventional
colonoscopy afterward for further assessment or treatment, such
as with biopsy or polypectomy.
Visual (endoscopic) examination of the abdomen with a
laparoscope inserted through small incisions in the abdomen.
Laparoscopic cholecystectomy (see Figure 5-28, page 160) and
laparoscopic appendectomy are performed by gastrointestinal
and general surgeons. See the In Person: Cholecystectomy story
of a woman who underwent laparoscopic cholecystectomy (see
page 191).
Removal of liver tissue for microscopic examination.
A physician inserts a needle through the skin to remove a small
piece of tissue for microscopic examination. The average sample
is less than 1 inch long. The procedure helps doctors diagnose
cirrhosis, chronic hepatitis, and tumors of the liver.
Insertion of a tube through the nose into the stomach.
Physicians use a nasogastric (NG) tube to remove fluid from the
stomach and intestines postoperatively (NG decompression). See
Figure 6-11.
Puncture to remove fluid from the abdomen.
This procedure is necessary to drain fluid (accumulated in ascites)
from the peritoneal (abdominal) cavity.
373
FIGURE 6-7 A. Sleeve gastrectomy. B. Gastric bypass. First
(a) the stomach is stapled so that it is reduced in size to a small
pouch. Next (b) a shortened jejunum is brought up to connect
with the smaller stomach. This diverts food so that it has a
shorter travel time through the intestine and less food is
absorbed into the bloodstream.
FIGURE 6-8 A, Normal endoscopy of the esophagus. B,
Esophagogastroduodenoscopy. This endoscopic view shows
severe esophagitis in a patient who had gastroesophageal reflux
disease (GERD).
374
FIGURE 6-9 Colonoscopy with polypectomy. Before the
procedure, the patient ingests agents to clean the bowel of feces.
The patient is sedated, and the gastroenterologist advances the
instrument in retrograde fashion, guided by images from a video
camera on the tip of the colonoscope. When a polyp is located, a
wire snare is passed through the endoscope and looped around
the stalk. After the loop is gently tightened, an electrical current is
applied to cut through the stalk. The polyp is removed (biopsy)
for microscopic tissue examination.
375
FIGURE 6-10 Colonoscopy case report. A 60-year-old man
with a history of multiple and prominent colon adenomas (with
some areas of high-grade dysplasia) underwent colonoscopy.
The endoscope was passed through the anus and advanced to
the cecum. Two pedunculated polyps (arrows) were found at the
hepatic flexure. Polypectomy was performed using a hot snare.
Resection and retrieval were complete.
FIGURE 6-11 Nasogastric intubation. The nasogastric tube is
suctioning secretions from the patient's stomach and intestines.
The patient had a twisted blocked intestine (ileus), and the
suction relieved pressure so that the intestine unwound and
decompressed without surgery.
376
Abbreviations
AFP
alk
phos
ALT,
AST
BE
BM
BRBPR
CD
CIC
CT
EGD
EPI
ERCP
ESLD
EUS
FOBT
G tube
GAVE
alpha-fetoprotein—tumor marker for liver cancer
alkaline phosphatase
alanine transaminase, aspartate transaminase—enzymes measured in blood to
evaluate liver function
barium enema
bowel movement
bright red blood per rectum—hematochezia
celiac disease
chronic idiopathic constipation
computed tomography
esophagogastroduodenoscopy
exocrine pancreatic insufficiency
endoscopic retrograde cholangiopancreatography
end-stage liver disease
endoscopic ultrasonography
fecal occult blood test
gastrostomy tube—feeding tube
gastric antral vascular ectasia—dilated small blood vessels in the antrum (the last
part of the stomach)
GB
gallbladder
GERD gastroesophageal reflux disease
GI
gastrointestinal
HBV
hepatitis B virus
IBD
inflammatory bowel disease (Crohn disease and ulcerative colitis)
J-tube jejunostomy tube—feeding tube
LAC
laparoscopic-assisted colectomy
LAP
laparoscopic
LFTs
liver function tests—alk phos, bilirubin, AST, ALT
MRI
magnetic resonance imaging
NASH nonalcoholic steatohepatitis (fa y liver)
NG
nasogastric tube
tube
NPO
nothing by mouth (Latin nil per os)
PEG
percutaneous endoscopic gastrostomy tube—feeding tube
tube
PEJ
percutaneous endoscopic jejunostomy tube—feeding tube
tube
PTHC percutaneous transhepatic cholangiography
PUD
peptic ulcer disease
TPN
total parenteral nutrition
Intravenous solutions contain sugar, amino acids, electrolytes, and vitamins.
T-tube special tube (shaped like the le er T) placed in the bile duct for drainage into a
small pouch (bile bag) on the outside of the body
In Person
377
Cholecystectomy
This first-person narrative describes the symptoms and treatment of a woman
with gallbladder stones.
Everyone enjoys a li le dessert after dinner, but when the ice cream
or a creamy tart leads to pain, most would avoid it. I loved sweets, and
despite the revenge they took on my waistline, I still would not pass up
an ice cream cone—until my gallbladder decided it had had enough.
After several late nights spent doubled over in pain, I tried to steer clear
of fa y foods but could not resist the temptation of frozen yogurt.
With one hand, I pushed my cart through the supermarket; with the
other hand, I fed myself some delicious low-fat (not nonfat) frozen
yogurt. I never dreamed that the a endant at the quick-service window
actually gave me soft-serve ice cream. Within 10 minutes of eating the
questionable yogurt, I broke out into a sweat; a wave of nausea took
me, and a knifelike pain stabbed me in my right upper quadrant. It hurt
even more when I pressed my hand on the area in an a empt to brace
against the pain.
Several months earlier, after a similar painful episode, I had
undergone an ultrasound of my gallbladder, and the surgeon then
recommended cholecystectomy. The U/S showed multiple stones in my
gallbladder. Most of the stones were just the right size to lodge in the
common bile duct and cause blockage of the outflow of bile that occurs
after a fa y meal. When I heard the ultrasound results, I swore off all
fa y foods.
I just did not imagine that ice cream masquerading as “low-fat
yogurt” would be the straw that broke the camel's back! Soon enough, I
abandoned my shopping cart and apologized to the manager of the
store for vomiting all over aisle 4. The unrelenting pain did not cease
when I vomited—it only intensified. I have no idea how I made it home
and into bed, but my husband found me several hours later in a deep
sweat. I managed to call my surgeon and arrange for “semi-emergent”
surgery the next morning.
378
Dr. Fernandez and his team performed a laparoscopic
cholecystectomy and relayed to me as I came out of anesthesia that I no
longer had a “bag of marbles” for a gallbladder. I had a gassy,
distended feeling in my abdomen over the two weeks after surgery
(carbon dioxide gas was injected into the abdomen before surgery to
allow space between abdominal organs). I felt “tight as a drum” for the
first few days, and then day by day it went away. My four tiny
incisions healed just fine, and in about 2 weeks I was feeling back to
“normal.” Now I can eat ice cream to my heart's content, only suffering
the padding on my waistline, not the stabbing pain just above. Without
missing a beat, my liver now delivers the bile into my small intestine
right after I eat a fa y meal. The bile emulsifies (breaks down) the fat. I
just don't have a storage bag to hold bile in reserve.
I've had an appendectomy, my wisdom teeth removed, and now I
gave up my gallbladder! How many more “useless” body parts are
there to go?
Elizabeth Chabner Thompson is the CEO/Founder of Masthead, a company
devoted to bringing innovative products to patients with breast cancer. She is a
physician, swimmer, cross country skier and the proud mother of four children
ages 16-21.
Practical Applications
Answers to the questions about the case report are on page 199.
Case Report: Pancreatic Cancer and Whipple
Procedure
A 62-year-old man came to the ED (emergency department) with
complaints of fatigue, weight loss, jaundice, and anorexia. Diagnostic
studies including abdominal CT with contrast, ERCP, and EUS were
performed. The CT scan showed a resectable 4-cm mass at the head of
the pancreas, and ERCP revealed evidence of bile duct obstruction; a
stent was placed to open the duct. Examination of a tissue biopsy
specimen obtained under U/S guidance confirmed an adenocarcinoma
of the head of the pancreas.
Additional studies showed no evidence of hepatic or other
metastases. Surgical treatment with a Whipple procedure was
recommended. This procedure was performed and included
pancreatoduodenectomy, choledochojejunostomy, and
gastrojejunostomy. Lymph node removal and cholecystectomy were
part of the operative procedure. During surgery, it was determined that
the tumor was confined to the head of the pancreas. Despite removal of
379
the tumor, the chance of recurrence is high, with a cure rate of only
about 20%.
Questions about the Case Report
1. What caused the patient's jaundice?
a. Excessive hemolysis
b. Viral hepatitis
c. Bile duct obstruction
d. Cholelithiasis
2. What test identified the mass as adenocarcinoma?
a. Whipple procedure
b. Biopsy with endoscopic ultrasonography
c. CT scan with contrast
d. ERCP
3. Which is included in a Whipple procedure?
a. Removal of the pancreas (malignant area) and duodenum
b. Removal of the gallbladder
c. Removal of lymph nodes
d. All of the above
4. What anastomosis was performed?
a. Gallbladder and duodenum united.
b. Common bile duct, pancreatic duct, and small intestine all
connected together.
c. Stomach and pancreas reconnected.
d. Liver and pancreas connected to the stomach.
380
Exercises
Remember to check your answers carefully with the Answers to
Exercises, pages 198 and 199.
A Give the meanings of the following suffixes.
1. -pepsia
_____________________________________________
_____________________________
2. -ptysis
_____________________________________________
_____________________________
3. -emesis
_____________________________________________
_____________________________
4. -phagia
_____________________________________________
_____________________________
5. -rrhea
_____________________________________________
_____________________________
6. -rrhage, -rrhagia
_____________________________________________
_____________________________
7. -rrhaphy
_____________________________________________
_____________________________
8. -plasty
_____________________________________________
_____________________________
9. -ectasis, -ectasia
_____________________________________________
_____________________________
381
10. -stenosis
_____________________________________________
_____________________________
11. -stasis
_____________________________________________
_____________________________
12. -spasm
_____________________________________________
_____________________________
13. -tresia
_____________________________________________
_____________________________
B Build medical terms for the definitions that follow.
Use the listed combining forms as appropriate to
create terms.
chol/e
cholangi/o
choledoch/o
gastr/o
hemat/o
hem/o
herni/o
palat/o
pylor/o
1. stoppage of bile (flow)
______________________________________
2. suture of a hernia
______________________________________
3. dilation of bile ducts
______________________________________
382
4. spi ing up blood (from the respiratory tract)
______________________________________
5. vomiting blood (from the digestive tract)
______________________________________
6. surgical repair of roof of the mouth
______________________________________
7. narrowing of the pyloric sphincter
______________________________________
8. bursting forth of blood from the stomach
______________________________________
9. sudden, involuntary contraction of muscles at the
distal region of the stomach
_____________________________________
10. bursting forth of blood
______________________________________
11. incision of the common bile duct
______________________________________
C Give the meanings of the following terms.
1. dysphagia
_____________________________________________
___________________________
2. polyphagia
_____________________________________________
___________________________
3. dyspepsia
_____________________________________________
___________________________
4. biliary atresia
_____________________________________________
___________________________
383
5. rhinorrhea
_____________________________________________
___________________________
6. cholestasis
_____________________________________________
___________________________
7. esophageal atresia
_____________________________________________
___________________________
8. pyloroplasty
_____________________________________________
___________________________
9. splenorrhagia
_____________________________________________
___________________________
10. proctosigmoidoscopy
_____________________________________________
___________________________
11. hemorrhage
_____________________________________________
___________________________
12. cholangitis
_____________________________________________
___________________________
D Match the listed surgical procedures with the
meanings that follow.
abdominoplasty
cecostomy
cholecystectomy
cholecystojejunostomy
384
colectomy
gingivectomy
herniorrhaphy
ileostomy
palatoplasty
pancreatoduodenectomy
paracentesis
sphincterotomy
1. removal of the gallbladder
____________________________
2. large bowel resection
____________________________
3. suture of a weakened muscular wall (hernia)
____________________________
4. new opening of the first part of the colon to the
outside of the body
____________________________
5. surgical repair of the abdomen
____________________________
6. incision of a ring of muscles
____________________________
7. removal of the pancreas and duodenum
____________________________
8. opening of the third part of the small intestine to
the outside of the body
____________________________
9. removal of gum tissue
____________________________
10. anastomosis between the gallbladder and second
part of the small intestine
385
p
____________________________
11. puncture of the abdomen for withdrawal of fluid
____________________________
12. surgical repair of the roof of the mouth
____________________________
E Use the given meanings to complete the following
terms.
1. discharge of fat: steat ________________________
2. difficulty in swallowing: dys
________________________
3. abnormal condition of gallstones: chole
________________________
4. pertaining to the cheek: ________________________
al
5. pertaining to lips and teeth:
________________________ dental
6. vomiting blood: hemat ________________________
7. enlargement of the liver: hepato
________________________
8. pertaining to under the tongue: sub
________________________
9. removal of the gallbladder:
________________________ ectomy
10. pertaining to the common bile duct: chole
________________________
11. hemorrhage from the stomach: gastro
________________________
F Give the meanings of the following terms.
386
1. cecal volvulus
_____________________________________________
_______________________
2. aphthous stomatitis
_____________________________________________
_______________________
3. celiac disease
_____________________________________________
_______________________
4. lipase
_____________________________________________
_______________________
5. cheilosis
_____________________________________________
_______________________
6. oropharynx
_____________________________________________
_______________________
7. glycogen
_____________________________________________
_______________________
8. glossectomy
_____________________________________________
_______________________
9. sialadenectomy
_____________________________________________
_______________________
10. periodontal membrane
_____________________________________________
_______________________
387
11. choledochectasia
_____________________________________________
_______________________
12. cholangiocarcinoma
_____________________________________________
_______________________
G Match each listed laboratory test or clinical
procedure with its description.
• abdominal ultrasonography
• barium enema
• CT scan of the abdomen
• endoscopic retrograde cholangiopancreatography
• endoscopic ultrasonography
• bariatric surgery/gastric bypass
• gastrostomy (G tube)
• HIDA scan
• laparoscopy
• liver biopsy
• nasogastric intubation
• percutaneous transhepatic cholangiography
• serum bilirubin
• small bowel follow-through
• stool culture
• stool guaiac (Hemoccult)
1. measurement of bile pigment in the blood
_________________________________
2. placement of feces in a growth medium for
bacterial analysis
_________________________________
388
3. x-ray examination of the lower gastrointestinal
tract _________________________________
4. imaging of abdominal viscera using sound waves
_________________________________
5. test to reveal hidden blood in feces
_________________________________
6. sequential x-ray images of the small intestine
_________________________________
7. injection of contrast material through the skin into
the liver, to obtain x-ray images of bile vessels
_________________________________
8. insertion of a tube through the nose into the
stomach _________________________________
9. transverse x-ray pictures of the abdominal organs
_________________________________
10. injection of contrast material through an
endoscope for x-ray imaging of the pancreas and
bile ducts _________________________________
11. reduction of stomach size and gastrojejunostomy
_________________________________
12. insertion of an endoscope and use of ultrasound
imaging to visualize the organs of the
gastrointestinal tract
_________________________________
13. percutaneous removal of liver tissue followed by
microscopic examination
_________________________________
14. visual examination (endoscopic) of abdominal
viscera through small abdominal incisions
_________________________________
389
15. new opening of the stomach to the outside of the
body for feeding
_________________________________
16. radioactive imaging of the liver, gallbladder, and
intestine _________________________________
H Give the meanings of the abbreviations in Column
I. Then select the le er of the correct description
from Column II.
COLUMN I
1. TPN
___________________
2. PUD
___________________
3. EGD
___________________
4. IBD ___________________
5. BE ___________________
6. BRBPR
___________________
7. LFTs
___________________
8. GERD
___________________
9. HBV
___________________
10. CT
___________________
_______
_______
_______
_______
_______
_______
_______
_______
COLUMN II
A. Tests such as measurement of ALT, AST, alk phos, and serum
bilirubin.
B. Heartburn is a symptom of this condition.
C. Includes Crohn disease and ulcerative colitis.
D. H. pylori causes this condition.
E. Intravenous injection of nutrition.
F. This is a lower gastrointestinal series.
G. X-ray procedure that produces a series of cross-sectional
images.
H. This infectious agent causes chronic inflammation of the liver.
I. Hematochezia describes this gastrointestinal symptom.
J. Endoscopic visualization of the upper gastrointestinal tract.
_______
_______
I Give the suffixes for the following terms.
1. bursting forth (of blood)
_________________________
2. flow, discharge _________________________
3. suture _________________________
4. dilation _________________________
5. narrowing (stricture) _________________________
6. vomiting _________________________
7. spi ing _________________________
8. excision _________________________
390
9. digestion _________________________
10. eating, swallowing _________________________
11. hardening _________________________
12. stopping, controlling _________________________
13. surgical repair _________________________
14. opening _________________________
15. surgical puncture _________________________
16. involuntary contraction
_________________________
17. new opening _________________________
18. incision _________________________
J Explain what happens in a fecal transplant and why
it is necessary. ________________________
________________________
________________________
________________________
________________________
________________________
________________________
K Circle the correct bold term in parentheses to
complete each sentence.
1. When Mrs. Smith began to have diarrhea and
crampy abdominal pain, she consulted a
(urologist, nephrologist, gastroenterologist) and
worried that the cause of her symptoms might be
(inflammatory bowel disease, esophageal varices,
achalasia).
2. After taking a careful history and performing a
thorough physical examination, Dr. Blakemore
diagnosed Mr. Bean, a longtime drinker, with
391
(hemorrhoids, pancreatitis, appendicitis). Mr.
Bean had complained of sharp midepigastric pain
and a change in bowel habits.
3. Many pregnant women cannot lie flat after eating
without experiencing a burning sensation in their
chest and throat. The usual cause of this symptom
is (volvulus, dysentery, gastroesophageal reflux).
4. Mr. and Mrs. Cho brought their infant son to the
clinic after he had several bouts of projectile
vomiting. The pediatric surgeon suspected a
diagnosis of (inguinal hernia, pyloric stenosis,
ascites).
5. Boris had terrible problems with his teeth. He
needed not only a periodontist for his (aphthous
stomatitis, oral leukoplakia, gingivitis) but also
an (endodontist, oral surgeon, orthodontist) to
straighten his teeth.
6. After 6 weeks of radiation therapy to her throat,
Be y experienced severe esophageal irritation and
inflammation. She complained to her doctor about
her resulting (dyspepsia, dysphagia,
hematemesis).
7. Steven, age 7 years, is brought to the clinic because
of recurrent abdominal pain, occasional
constipation and diarrhea, and weight loss. His
pediatrician's diagnosis is (lipase deficiency,
dysentery, celiac disease) and recommends a (fat,
gluten, sugar)-free diet.
8. Chris had been a heavy alcohol drinker all of his
adult life. His wife noticed worsening yellow
discoloration of the whites of his eyes and skin.
After a physical examination and blood tests, his
392
family physician told him his (colon, skin, liver)
was diseased. The yellow discoloration was
(jaundice, melena, flatus), and his condition was
(cheilosis, cirrhosis, steatorrhea).
9. When Carol was working as a phlebotomist, she
accidentally cut her finger while drawing a
patient's blood. Unfortunately the patient had
(pancreatitis, hemoptysis, hepatitis), and HBV
was transmi ed to Carol. Blood tests and (liver
biopsy, gastrointestinal endoscopy, stool culture)
confirmed Carol's unfortunate diagnosis. Her
doctor told her that her condition was chronic and
that she might be a candidate for a (bone marrow,
liver, kidney) transplant procedure in the future.
10. Operation Smile is a rescue project that performs
surgical repair including (herniorrhaphy, oral
gingivectomy, palatoplasty) on children with a
congenital cleft in the roof of the mouth.
11. After months of treatment with antibiotics, Anne
developed abdominal pain and chronic severe
diarrhea. Harmful bacteria C. difficile took over her
(stomach, colon, esophagus). To restore normal
bacteria to the gut, she received a (gastric bypass,
laparoscopic sleeve gastrectomy, fecal transplant).
393
Answers to Exercises
A
1. digestion
2. spi ing (from the respiratory tract)
3. vomiting
4. eating, swallowing
5. flow, discharge
6. bursting forth of blood
7. suture
8. surgical repair
9. dilation (dilatation), widening
10. narrowing, tightening
11. to stop; control
12. sudden, involuntary contraction of muscles
13. opening
B
1. cholestasis
2. herniorrhaphy
3. cholangiectasia
4. hemoptysis
5. hematemesis
6. palatoplasty
394
7. pyloric stenosis
8. gastrorrhagia
9. pylorospasm
10. hemorrhage
11. choledochotomy
C
1. difficulty in swallowing
2. excessive (much) eating
3. difficult digestion
4. biliary ducts are not open (congenital anomaly)
5. discharge of mucus from the nose
6. stoppage of flow of bile
7. esophagus is not open (closed off) at birth (congenital
anomaly)
8. surgical repair of the pyloric sphincter
9. bursting forth of blood (hemorrhage) from the spleen
10. visual (endoscopic) examination of the rectum and
sigmoid colon
11. bursting forth of blood
12. inflammation of bile duct (vessel)
D
1. cholecystectomy
2. colectomy
395
3. herniorrhaphy
4. cecostomy
5. abdominoplasty
6. sphincterotomy
7. pancreatoduodenectomy
8. ileostomy
9. gingivectomy
10. cholecystojejunostomy
11. paracentesis (abdominocentesis)
12. palatoplasty
E
1. steatorrhea
2. dysphagia
3. cholelithiasis
4. buccal
5. labiodental
6. hematemesis
7. hepatomegaly
8. sublingual
9. cholecystectomy
10. choledochal
11. gastrorrhagia
F
396
1. twisted intestine in the area of the cecum
2. inflammation of the mouth with small ulcers
3. autoimmune disorder in which villi in the lining of
the small intestine are damaged, resulting from
reaction to dietary glutens such as wheat, barley, and
rye
4. enzyme to digest fat
5. abnormal condition of lips
6. the part of the throat near the mouth
7. storage form of sugar
8. removal of part or all of the tongue
9. removal of a salivary gland
10. membrane surrounding a tooth
11. dilation of the common bile duct
12. malignant tumor of bile vessels
G
1. serum bilirubin
2. stool culture
3. barium enema
4. abdominal ultrasonography
5. stool guaiac (Hemoccult)
6. small bowel follow-through
7. percutaneous transhepatic cholangiography (PTHC)
8. nasogastric intubation
397
9. CT scan of the abdomen
10. endoscopic retrograde cholangiopancreatography
(ERCP)
11. bariatric surgery (gastric bypass)
12. endoscopic ultrasonography (EUS)
13. liver biopsy
14. laparoscopy (form of minimally invasive surgery)
15. gastrostomy (G tube)
16. HIDA scan
H
1. total parenteral nutrition: E
2. peptic ulcer disease: D
3. esophagoduodenoscopy: J
4. inflammatory bowel disease: C
5. barium enema: F
6. bright red blood per rectum: I
7. liver function tests: A
8. gastroesophageal reflux disease: B
9. hepatitis B virus: H
10. computed tomography: G
I
1. -rrhagia, -rrhage
2. -rrhea
398
3. -rrhaphy
4. -ectasis, -ectasia
5. -stenosis
6. -emesis
7. -ptysis
8. -ectomy
9. -pepsia
10. -phagia
11. -sclerosis
12. -stasis
13. -plasty
14. -tresia
15. -centesis
16. -spasm
17. -stomy
18. -tomy
J
In a fecal transplant, stool from a healthy donor, is transferred into the
colon of a patient/recipient. This is necessary when the patient’s colon
contains harmful bacteria, such as C. difficile. After transplant, normal
stool bacteria populate the colon of the patient.
K
1. gastroenterologist; inflammatory bowel disease
2. pancreatitis
399
3. gastroesophageal reflux
4. pyloric stenosis
5. gingivitis; orthodontist
6. dysphagia
7. celiac disease; gluten
8. liver; jaundice; cirrhosis
9. hepatitis; liver biopsy; liver
10. palatoplasty
11. colon; fecal transplant
Answers to Practical Applications
Case Report: Pancreatic Cancer and Whipple Procedure
1. c
2. b
3. d
4. b
Pronunciation of Terms
The terms you have learned in this chapter are presented here with
their pronunciations. The meanings for all the terms are in the MiniDictionary beginning on page 897. You can also hear each term
pronounced on the Evolve website
(h p://evolve.elsevier.com/Chabner/language/).
400
TERM
abdominal ultrasonography
abdominoplasty
amylase and lipase tests
aphthous stomatitis
atresia
bariatric surgery
biliary atresia
bronchospasm
buccal
cecal volvulus
celiac disease
cheilosis
cholangiectasis
cholangiocarcinoma
cholangiography
cholangiopancreatography
cholangitis
cholecystectomy
cholecystojejunostomy
cholecystolithiasis
choledochal
choledochectasia
cholelithiasis
cholestasis
colectomy
colonoscopy
computed tomography
dentalgia
diarrhea
duodenal
dyspepsia
dysphagia
endoscopic ultrasonography
esophageal atresia
fecal transplant
gastroenteritis
gastrointestinal endoscopy
gastrojejunostomy
gastrorrhagia
gastrostomy
gingivectomy
glossectomy
gluconeogenesis
glycogen
hematemesis
hemoptysis
hemorrhage
hepatomegaly
herniorrhaphy
HIDA scan
ileostomy
labiodental
PRONUNCIATION
ab-DOM-in-al ul-trah-so-NOG-rah-fe
ab-DOM-in-o-plas-te
AM-ih-lays and LI-pays tests
AF-thus sto-mah-TI-tis
a-TRE-ze-ah
bah-re-AH-trk SUR-jeh-re
BIH-le-ah-re a-TRE-ze-ah
BRONG-ko-spasm
BUK-al
SE-kal VOL-vu-lus
SE-le-ak dih-ZEEZ
ki-LO-sis
ko-lan-je-EK-tah-sis
ko-lan-je-o-kar-sih-NO-mah
ko-lan-je-OG-rah-fe
ko-lan-je-o-pan-kre-uh-TOG-rah-fe
ko-lan-JI-tis
ko-le-sis-TEK-to-me
ko-le-sis-to-jeh-jun-NOS-to-me
ko-le-sis-to-lih-THI-ah-sis
ko-le-DOK-al
ko-le-do-kek-TA-se-ah
ko-le-lih-THI-ah-sis
ko-le-STA-sis
ko-LEK-to-me
ko-lon-OS-ko-pe
kom-PU-ted to-MOG-rah-fe
den-TAL-jah
di-ah-RE-ah
du-o-DE-nal
dis-PEP-se-ah
dis-FA-je-ah
en-do-SKOP-ikul-trah-so-NOG-rah-fe
eh-sof-ah-JE-al a-TRE-ze-ah
fe-kal tranz-plant
gas-tro-en-teh-RI-tis
gas-tro-in-TES-tih-nal en-DOS-ko-pe
gas-tro-jeh-ju-NOS-to-me
gas-tro-RA-jah
gas-TROS-to-me
gin-gih-VEK-to-me
glos-EK-to-me
glu-ko-ne-o-JEN-eh-sis
GLI-ko-jen
he-mah-TEM-eh-sis
he-MOP-tih-sis
HEM-or-ij
hep-ah-to-MEG-ah-le
her-ne-OR-ah-fe
HIH-dah skan
il-e-OS-to-me
la-be-o-DEN-tal
401
TERM
laparoscopy
lipase
liver biopsy
liver function tests
lower gastrointestinal series
magnetic resonance imaging
nasogastric intubation
oropharynx
palatoplasty
pancreatic
pancreatoduodenectomy
paracentesis
periodontal membrane
polyphagia
proctosigmoidoscopy
pyloric stenosis
pylorospasm
rectal carcinoma
sialadenectomy
splenic flexure
steatorrhea
stool culture
stool guaiac
sublingual
upper gastrointestinal series
PRONUNCIATION
lap-ah-ROS-ko-pe
LI-pays
LIV-er bi-OP-se
LIV-er FUNK-shun tests
LO-er gas-tro-in-TES-tin-al SE-reez
mag-NET-ik REH-zo-nants IM-aj-ing
na-zo-GAS-trik in-tu-BA-shun
or-o-FAH-rinks
pah-LAT-o-plas-te
pan-kre-AH-tik
pan-kre-ah-to-du-o-deh-NEK-to me
par-ah-sen-TE-sis
peh-re-o-DON-tal MEM-brayn
pol-e-FA-je-ah
prok-to-sig-moyd-OS-ko-pe
pi-LOR-ik steh-NO-sis
pi-LOR-o-spasm
REK-tal kar-sih-NO-mah
si-al-ah-deh-NEK-to-me
SPLEN-ik FLEK-shur
ste-ah-to-RE-ah
stool KUL-chur
stool GWI-ak
sub-LING-wal
UP-er gas-tro-in-TEST-in-al SER-eez
Review Sheet
Write meanings for combining forms and suffixes in the spaces
provided. Check your answers with information in Chapter 5 and this
chapter or in the Glossary (Medical Word Parts—English) at the end of
this book.
Combining Forms
402
COMBINING FORM
abdomin/o
amyl/o
an/o
append/o, appendic/o
bil/i
bilirubin/o
bucc/o
cec/o
celi/o
cervic/o
cheil/o
chlorhydr/o
chol/e
cholangi/o
cholecyst/o
choledoch/o
cib/o
cirrh/o
col/o, colon/o
dent/i
duoden/o
enter/o
esophag/o
eti/o
gastr/o
gingiv/o
gloss/o
gluc/o, glyc/o
glycogen/o
hem/o, hemat/o
hepat/o
herni/o
idi/o
ile/o
pancreat/o
peritone/o
pharyng/o
proct/o
prote/o
py/o
pylor/o
rect/o
sialaden/o
splen/o
steat/o
stomat/o
tonsill/o
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Suffixes
403
SUFFIX
-ase
-centesis
-chezia
-ectasia
-ectasis
-ectomy
-emesis
-emia
-genesis
-graphy
-iasis
-megaly
-orexia
-ptosis
-rrhage
-rrhagia
-rrhaphy
-rrhea
-scopy
-spasm
-stasis
-stenosis
-stomy
-tomy
-tresia
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
404
CHAPTER 7
405
Urinary System
CHAPTER SECTIONS
Introduction 204
Anatomy of the Major Organs 204
Physiology: How the Kidneys Produce Urine 206
Vocabulary 209
Terminology: Structures, Substances, and Urinary Signs and
Symptoms 211
Urinalysis 216
Pathologic Terminology: Kidney, Bladder, and Associated
Conditions 217
Laboratory Tests and Clinical Procedures 220
Abbreviations 225
Practical Applications 226
In Person: Kidney Transplant 228
Exercises 229
Answers to Exercises 234
Pronunciation of Terms 236
Review Sheet 238
CHAPTER GOALS
• Name essential organs of the urinary system and describe their locations and
functions.
• Identify common pathologic conditions affecting the urinary system.
• Recognize how urinalysis is used and interpreted as a diagnostic test.
• Define urinary system–related combining forms, prefixes, and suffixes.
• List and explain laboratory tests, clinical procedures, and abbreviations that
pertain to the urinary system.
406
• Understand medical terms in their proper contexts, such as medical reports and
records.
407
Introduction
When foods containing proteins are used by cells in the body, nitrogenous
waste products (urea, creatinine, and uric acid) are released into the
bloodstream. The urinary system removes these nitrogenous wastes from the
blood so that they do not accumulate and become harmful. As blood passes
through the kidneys, the kidneys filter nitrogenous wastes to form urine
(composed of water, salts, and acids). Urine leaves the body through the
ureters, urinary bladder, and urethra. Every day, the kidneys process about
200 quarts of blood to filter out 2 quarts of urine.
Besides removing urea and other nitrogenous wastes from the blood, the
kidneys maintain the proper balance of water, electrolytes, and acids in body
fluids. Electrolytes such as sodium (Na+) and potassium (K+) are small
molecules that conduct an electrical charge. Electrolytes are necessary for
proper functioning of muscle and nerve cells. The kidney adjusts the
amounts of water and electrolytes by secreting some substances into the
urine and holding back others in the bloodstream for use in the body. This is
an example of homeostasis, which is the body's ability to maintain an
equilibrium within its internal environment. Home/o means sameness.
In addition to forming and excreting (eliminating) urine from the body,
the kidneys secrete an enzyme called renin (RE-nin) and a hormone called
erythropoietin (eh-rith-ro-POY-it-in). Renin raises blood pressure (to keep
blood moving through the kidney). Erythropoietin (EPO) stimulates red
blood cell production in the bone marrow.
The kidneys also secrete calciferol, an active form of vitamin D, necessary
for the absorption of calcium from the intestine. In addition, the kidneys
degrade and eliminate hormones such as insulin and parathyroid hormone
from the bloodstream. Box 7-1 reviews the functions of the kidneys.
Box 7-1
Functions of The Kidneys
• Remove nitrogenous wastes: urea, creatinine, uric acid
• Balance water and electrolytes (sodium, potassium)
• Release substances: renin, erythropoietin, calciferol
• Degrade and eliminate hormones from bloodstream
408
Anatomy of the Major Organs
The following paragraphs describe the organs of the urinary system. Label
Figure 7-1 as you identify each organ.
FIGURE 7-1 Male urinary system.
The kidney [1] is one of two bean-shaped organs behind the abdominal
cavity (retroperitoneal) on either side of the spine in the lumbar region. A
cushion of adipose (fa y) tissue and fibrous connective tissue surrounds
each kidney for protection. Each kidney (about the size of a fist) weighs
about 4 to 6 ounces.
The kidneys consist of an outer cortex region (cortex means bark, as the
bark of a tree) and an inner medulla region (medulla means marrow). The
hilum is a depression on the medial border of the kidney. Blood vessels and
nerves pass through the hilum.
409
The ureter [2] is one of two muscular tubes (16 to 18 inches long) lined
with mucous membrane. Ureters carry urine in peristaltic waves from the
kidneys to the urinary bladder.
The urinary bladder [3], a hollow, muscular sac, is a temporary reservoir
for urine. The trigone is a triangular region at the base of the bladder where
the ureters enter and the urethra exits.
The urethra [4] is a tube that carries urine from the urinary bladder to the
outside of the body. The process of expelling urine through the urethra is
called urination or voiding. The external opening of the urethra is the
urinary meatus. The male urethra, about 8 inches long, extends downward
through the prostate gland to the urinary meatus, at the tip of the penis. In
the female urinary system, the urethra, about 2 inches long, lies anterior to
the vagina. See Figure 7-2A, which illustrates the female urinary system.
When a patient can't empty his/her bladder, a tube called a catheter is often
inserted through the urethra to drain urine from the bladder. See Figure 72B.
FIGURE 7-2 A. Female urinary system. B. Urinary catheter
placement.
410
Physiology: How the Kidneys Produce
Urine
Blood enters each kidney from the aorta by way of the right and left renal
arteries. After the renal artery enters the kidney (at the hilum), it branches
into smaller and smaller arteries. The smallest arteries are called arterioles
(Figure 7-3A).
FIGURE 7-3 A, Renal artery branching to form smaller arteries and
arterioles, and glomeruli. B, Glomerulus and glomerular capsule.
Afferent arteriole carries blood toward (in this term, af- is a form of ad-)
the glomerulus. Efferent arteriole carries blood away (ef- is a form of
ex-) from the glomerulus.
Because the arterioles are small, blood passes through them slowly but
constantly. Blood flow through the kidney is so essential that the kidneys
have their own special device for maintaining blood flow. If blood pressure
falls in the vessels of the kidney so that blood flow diminishes, the kidney
produces renin and discharges it into the blood. Renin promotes the
formation of a substance that stimulates the contraction of arterioles. This
increases blood pressure and restores blood flow in the kidneys to normal.
Each arteriole in the cortex of the kidney leads into a mass of very tiny,
coiled, and intertwined smaller blood vessels called glomeruli (see Figure 73A). Each glomerulus (singular) is a collection of tiny capillaries formed in
the shape of a small ball. There are about 1 million glomeruli in the cortex
region of each kidney.
The kidneys produce urine by filtration. As blood passes through the
many glomeruli, the thin walls of each glomerulus (the filter) permit water,
salts, sugar, and urea (with other nitrogenous wastes such as creatinine and
uric acid) to leave the bloodstream. These materials collect in a tiny, cup-like
structure, a glomerular (Bowman) capsule, that surrounds each glomerulus
(Figure 7-3B). The walls of the glomeruli prevent large substances, such as
411
proteins and blood cells, from filtering into the urine. These substances
remain in the blood and normally do not appear in urine.
A ached to each glomerular capsule is a long, twisted tube called a renal
tubule (Figure 7-3B; see also Figure 7-4). As water, sugar, salts, urea, and
other wastes pass through the renal tubule, most of the water, all of the
sugar, and almost all of the sodium return to the bloodstream through tiny
capillaries surrounding each tubule. This active process of reabsorption
ensures that the body retains essential substances such as sugar (glucose),
water, and sodium while allowing waste products to be excreted in the
urine. The final process in the formation of urine is secretion of some
substances such as potassium, acids and drugs from the bloodstream into
the renal tubule. Each renal tubule, now containing urine (95% water and 5%
urea, creatinine, salts and acids) connects to a larger collecting tubule.
FIGURE 7-4 A, Three steps in the formation of urine: (1)
Glomerular filtration of water, sugar, wastes (urea and creatinine),
and sodium; (2) Tubular reabsorption of water, sugar, and sodium;
and (3) Tubular secretion of acids, potassium, and drugs. B, A
nephron is the combination of a glomerulus and a renal tubule.
See Figure 7-4A, which reviews the steps involved in urine formation.
Note that waste products may accumulate in the body as a result of kidney
failure and may interfere with the function of vital organs, including the
brain and heart. The combination of a glomerulus and a renal tubule forms a
unit called a nephron (Figure 7-4B). Each kidney contains about 1 million
nephrons.
All collecting tubules lead to the renal pelvis, a basin-like area in the
central part of the kidney. Small, cup-like regions of the renal pelvis are
412
called calyces or calices (singular: calyx or calix). Figure 7-5 is an x-ray
image of a kidney showing the renal pelvis, calyces, and ureter.
FIGURE 7-5 Renal pelvis, calyces, and ureter as seen on CT
urogram (intravenous dye was used).
The renal pelvis narrows into the ureter, which carries the urine to the
urinary bladder. The bladder, a muscular sac, temporarily stores urine.
Sphincter muscles control the exit area of the bladder to the urethra. As the
bladder fills and pressure increases at its base, an individual notices a need
to urinate and voluntarily relaxes sphincter muscles.
Study the diagram in Figure 7-6 tracing the process of urine formation and
excretion.
413
FIGURE 7-6 Flow diagram illustrating the process of forming and
expelling urine.
Vocabulary
414
arteriole
calciferol
calyx or calix
(plural: calyces
or calices)
catheter
Small artery.
Active form of vitamin D, secreted by the kidney.
Cup-like collecting region of the renal pelvis. The term comes from Greek, kalux
meaning a cup or case surrounding a flower bud.
Tube for injecting or removing fluids. A bladder catheter drains urine from the
bladder.
cortex
Outer region of an organ; the renal cortex is the outer region of the kidney
(cortical means pertaining to the cortex).
creatinine
Nitrogenous waste excreted in urine. Creatinine is a product of muscle
metabolism. Creatinine clearance is a measure of the efficiency of the kidneys in
removing (clearing) creatinine from the blood.
electrolyte
Chemical element that carries an electrical charge when dissolved in water.
Electrolytes are necessary for functioning of muscles and nerves. The kidneys
maintain the proper balance of electrolytes and water in the blood. Potassium
(K+) and sodium (Na+) are electrolytes.
erythropoietin Hormone secreted by the kidney to stimulate the production of red blood cells.
(EPO)
Poietin means a substance that forms. EPO stimulates red blood cell production
by bone marrow and thus increases the amount of oxygen delivered to muscles.
This enhances athletic endurance. However, use of EPO is a form of blood doping
and is prohibited by the World Anti-Doping Authority (WADA).
filtration
Process whereby some substances, but not all, pass through a filter.
glomerular
Enclosing structure surrounding each glomerulus. The glomerular capsule is also
capsule
known as Bowman capsule and collects the material that is filtered from the
blood through the walls of the glomerulus.
glomerulus
Tiny ball of capillaries (microscopic blood vessels) in the kidney.
(plural:
glomeruli)
hilum
Depression in the kidney where blood vessels and nerves enter and leave. Hilum
comes from the Latin meaning a small thing. It is also used in the respiratory
system to mark the depression in the lung where blood vessels, bronchus, and
lymphatic vessels enter and leave.
kidney
One of two bean-shaped organs on either side of the backbone in the lumbar
region. It filters nitrogenous wastes from the bloodstream to form urine.
meatus
Opening or canal.
medulla
Inner region of an organ. The renal medulla is the inner region of the kidney.
Medullary means pertaining to the medulla. The term comes from the Latin
medulla, meaning marrow (inner part).
nephron
Functional unit of the kidney. It is the combination of glomerulus and renal
tubule where filtration, reabsorption, and secretion take place in the kidney. Each
nephron is capable of forming urine by itself. There are about 1 million nephrons
in a kidney.
nitrogenous
Substance containing nitrogen and excreted in urine. Examples of nitrogenous
waste
wastes are urea, uric acid, and creatinine.
potassium
Electrolyte regulated by the kidney so that a proper concentration is maintained
within the blood. Potassium is essential for allowing muscle contraction and
(K+)
conduction of nervous impulses.
reabsorption Process whereby renal tubules return materials necessary to the body back into
the bloodstream.
renal artery
Blood vessel that carries blood to the kidney.
renal pelvis
Central collecting region in the kidney.
renal tubule
Microscopic tube in the kidney where urine is formed after filtration.
renal vein
Blood vessel that carries blood away from the kidney and toward the heart.
renin
Enzyme secreted by the kidney. It raises blood pressure by influencing
vasoconstriction (narrowing of blood vessels).
sodium (Na+) Electrolyte regulated in the blood and urine by the kidneys. It is needed for
proper transmission of nerve impulses, heart activity, and other metabolic
functions. A common form of sodium is sodium chloride (table salt).
415
trigone
urea
ureter
urethra
uric acid
urinary
bladder
urination
(voiding)
Triangular area in the urinary bladder.
Major nitrogenous waste excreted in urine.
One of the two tubes leading from the kidneys to the urinary bladder.
Tube leading from the urinary bladder to the outside of the body.
Nitrogenous waste excreted in the urine.
Hollow, muscular sac that holds and stores urine.
Process of expelling urine; also called micturition.
Filtration of Blood Through the Kidney
This process is maintained by output from the heart (25% of cardiac output
goes to the kidneys) and adequate blood pressure to force blood through the
glomerulus (filter). About 200 quarts (189 L) of fluid are filtered daily, but
98% to 99% of water and salts are returned to the blood. Only about 2 quarts
(1500 mL) of urine are excreted daily.
Terminology
Structures, Substances, and Urinary Signs and Symptoms
Write the meanings of the medical terms in the spaces provided.
Structures
416
COMBINING
MEANING TERMINOLOGY
MEANING
FORM
cali/o, calic/o calyx
caliectasis ________________________________________caliceal
(calix); cup- __________________________________________
shaped
cyst/o
urinary
cystitis __________________________________________
bladder
Bacterial infections often cause acute or chronic cystitis. In acute
cystitis, the bladder contains blood as a result of mucosal hemorrhage
(Figure 7-7).cystectomy
______________________________________cystostomy
______________________________________
An opening is made into the urinary bladder from the outside of the
body. A catheter is placed into the bladder for drainage.
glomerul/o
glomerulus glomerular capsule _________________________________
meat/o
meatus
meatal stenosis ____________________________________
nephr/o
kidney
paranephric ______________________________________
nephropathy ______________________________________
(neh-FROP-ah-the)
nephroptosis ______________________________________
Downward displacement or dropping of a kidney when its anatomic
supports are weakened. Nephropexy (-pexy means fixation) is an
operation to put a “floating” kidney in place.
nephrolithotomy __________________________________
Incision (percutaneous) into the kidney to remove a stone.
hydronephrosis ____________________________________
Obstruction of urine flow may be caused by renal calculi (Figure 7-8),
compression of the ureter by tumor, or hyperplasia of the prostate
gland at the base of the bladder in males.
nephrostomy ______________________________________
Surgical opening to the outside of the body (from the renal pelvis).
This is necessary when a ureter becomes obstructed and the
obstruction cannot be removed easily. The renal pelvis becomes
distended with urine (hydronephrosis), making nephrostomy
necessary.
pyel/o
renal pelvis
pyelolithotomy ____________________________________
Removal of a large calculus (stone) contributing to blockage of urine
flow and development of infection. The renal pelvis is surgically
opened.
ren/o
kidney
renal ischemia ____________________________________renal
colic ________________________________________
Colic is intermi ent spasms of pain caused by inflammation and
distention of an organ. In renal colic, pain results from calculi in the
kidney or ureter.
trigon/o
trigone
trigonitis _________________________________________
(region of
the
bladder)
ureter/o
ureter
ureteroplasty
______________________________________ureteroileostomy
__________________________________
After cystectomy, the urologic surgeon forms a pouch from a segment
of the ileum, used in place of the bladder to carry urine from ureters
out of the body (Figure 7-9). It is an ileal conduit.
urethr/o
urethra
urethritis
________________________________________urethroplasty
_____________________________________urethral stricture
_________________________________
A stricture is an abnormal narrowing of an opening or passageway.
417
COMBINING
MEANING TERMINOLOGY
MEANING
FORM
vesic/o
urinary
intravesical _______________________________________
bladder
Do not confuse the term vesical with the term vesicle, which is a
small blister on the skin.vesicoureteral reflux
________________________________
FIGURE 7-7 Acute cystitis. Notice that the mucosa of the bladder is
red and swollen. Bladder and urinary tract infections are more common
in women because of the shorter urethra, which allows easier bacterial
colonization of the urinary bladder. They usually occur without a known
cause but may be acquired during sexual intercourse (“honeymoon
cystitis”) or after surgical procedures and urinary catheterization.
418
FIGURE 7-8 A, Hydronephrosis caused by a stone (obstruction) in
the proximal part of a ureter. Notice the buildup of excess fluid in the
kidney. B, Hydroureter with hydronephrosis caused by a stone in the
distal part of the ureter.
419
FIGURE 7-9 Ileostomy and ileal conduit after cystectomy.
Substances and Urinary Signs and Symptoms
420
COMBINING
FORM OR
MEANING
SUFFIX
albumin/o
albumin
(a protein
in the
blood)
TERMINOLOGY
MEANING
albuminuria ____________________________________
The suffix -uria means urine condition. This finding can indicate
malfunction of the kidney as protein leaks out of damaged glomeruli.
Microalbuminuria is leakage of very small amounts of albumin
through the glomeruli.
azot/o
nitrogen
azotemia ____________________________________
This toxic condition is characteristic of uremia. It is indicated by an
elevated BUN (blood urea nitrogen) test.
bacteri/o
bacteria
bacteriuria ____________________________________
Usually a sign of urinary tract infection (UTI). The bacteria in
the urine are cultured (grown in a special nutrient environment)
and then tested with antibiotics to determine which will inhibit
growth. This is known as culture and sensitivity testing (C&S).
dips/o
thirst
polydipsia ____________________________________
Commonly, a sign of diabetes mellitus or diabetes insipidus.
Polydipsia occurs when excessive urination (polyuria) signals the
brain to cause thirst.
kal/i
potassium
hyperkalemia ____________________________________
Because potassium (K+) normally is excreted by the kidneys, it
accumulates in blood when the kidneys fail.
ket/o, keton/o
ketone
ketosis ____________________________________
bodies
Often called ketoacidosis, because acids accumulate in the blood
(ketoacids
and tissues. The breath of a patient with ketosis has a sweet or
and
“fruity” odor. This is produced by acetone (a ketone body) released
acetone)
from the blood in the lungs and exhaled through the
mouth.ketonuria ____________________________________
lith/o
stone
nephrolithiasis ____________________________________
natr/o
sodium
hyponatremia ____________________________________
This condition can occur when water intake is excessive—primary
polydipsia, or when athletes drink too much water in highendurance events.
noct/o
night
nocturia ____________________________________
Frequent, excessive urination at night.
olig/o
scanty
oliguria ____________________________________
-poietin
substance that erythropoietin ____________________________________
forms
py/o
pus
pyuria ____________________________________
-tripsy
crushing
lithotripsy ____________________________________
ur/o
urine (urea)
uremia ____________________________________
This toxic state results when nitrogenous waste accumulates
abnormally in the blood.enuresis
____________________________________
Literally, a condition (-esis) of being “in urine”; bed-we ing.
diuresis ____________________________________
Di- (from dia-) means complete. Caffeine and alcohol are wellknown diuretics—they induce increased excretion of urine
(diuresis).antidiuretic hormone
______________________________
This hormone from the pituitary gland normally acts on the renal
tubules to promote water reabsorption. It is also called vasopressin
and is abbreviated ADH.
421
COMBINING
FORM OR
MEANING
SUFFIX
urin/o
urine
-uria
urination;
urine
condition
TERMINOLOGY
MEANING
urinary incontinence ________________________________
Incontinence literally means not (in-) able to hold (tin) together
(con-). This is loss of control of the passage of urine from the
bladder. Stress incontinence occurs with strain on the bladder
opening during coughing or sneezing. Urgency incontinence
occurs with the inability to hold back urination when feeling the
urge to void.urinary retention
_______________________________
This symptom results when the outflow of urine from the bladder is
blocked.
dysuria __________________________________anuria
____________________________________
Commonly caused by renal failure or urinary tract
obstruction.hematuria
____________________________________
Microhematuria is hematuria that is visible only under a
microscope, as opposed to gross hematuria, which can be seen with
the naked eye.glycosuria
____________________________________
A sign of diabetes mellitus.polyuria
____________________________________
A symptom of both diabetes insipidus and diabetes mellitus.
Enuresis/Nocturia
Don't confuse enuresis, which is involuntary, with nocturia, which is
voluntary, frequent urination at night.
422
Urinalysis
Urinalysis is an examination of urine to determine the presence of abnormal
elements that may indicate various pathologic conditions. It is an
inexpensive, noninvasive test that provides valuable information not only
about the contents of urine, but about diseases affecting the body as a whole.
Urinalysis may be done in an office se ing with almost instant results. See
Figure 7-10.
FIGURE 7-10 Dipstick testing and urinalysis.
The following are some of the tests included in a urinalysis:
1. Color—Normal urine color is yellow (amber) or straw-colored. A
colorless, pale urine indicates a large amount of water in the urine,
whereas a smoky-red or brown color of urine indicates the presence
of large amounts of blood. Foods such as beets and certain drugs also
can produce a red coloration of urine.
2. Appearance—Normally, urine should be clear. Cloudy or turbid
urine indicates a urinary tract infection with pus (pyuria) and
bacteria (bacteriuria).
3. pH—Determination of pH reveals the chemical nature of urine. It
indicates to what degree a solution is acid or alkaline (basic) (Figure
7-11). Normal urine has a slightly acidic pH of 6.5. However, in some
infections of the bladder, the urine pH may be alkaline, owing to the
actions of bacteria in the urine that break down urea and release
ammonia (an alkaline substance).
423
FIGURE 7-11
The pH scale. Pure water has a neutral pH.
4. Protein—Small amounts of protein are normally found in the urine
but not in sufficient quantity to produce a positive result by ordinary
methods of testing. When urinary tests for protein become positive,
albumin is usually responsible. Albumin is the major protein in
blood plasma. If it is detected in urine (albuminuria), it may indicate
a leak in the glomerular membrane, which allows albumin to enter
the renal tubule and pass into the urine.
Through more sensitive testing, smaller abnormal amounts of
albumin may be detected, revealing microalbuminuria, when
ordinary tests are negative. Microalbuminuria is recognized as the
earliest sign of renal involvement in diabetes mellitus.
5. Glucose—Sugar is not normally found in the urine. In most cases,
when it does appear (glycosuria), it indicates diabetes mellitus. In
diabetes mellitus, there is excess sugar in the bloodstream
(hyperglycemia), which leads to the “spilling over” of sugar into the
urine. The renal tubules cannot reabsorb all the sugar that filters out
through the glomerular membrane.
6. Specific gravity—The specific gravity of urine reflects the amounts of
wastes, minerals, and solids in the urine. It is a comparison of the
density of urine with that of water. The urine of patients with
diabetes mellitus has a higher-than-normal specific gravity because
of the presence of sugar.
7. Ketone bodies—Ketones (or acetones, a type of ketone body) are
formed when fa y acids are broken down in the liver. Ketones
accumulate in blood and urine when the body breaks down fat,
instead of sugar, for fuel. Ketonuria occurs in diabetes mellitus when
cells deprived of sugar must use up their available fat for energy. In
starvation, when sugar is not available, ketonuria and ketosis
(ketones in the blood) occur as fat is catabolized abnormally.
Ketones in the blood are dangerous because they increase the acidity
of the blood (ketoacidosis). If severe, this may lead to coma
(unconsciousness) and death.
8. Sediment and casts—The presence of abnormal particles in the urine
is a sign of a pathologic condition. Such particles, which may se le to
the bo om of a urine sample as sediment, may include cells
(epithelial, white, or red blood cells), bacteria, crystals, and casts
(cylindrical structures of protein often containing cellular elements).
9. Phenylketonuria (PKU)—This is a rare condition in which a baby is
born unable to break down an amino acid, phenylalanine. Resulting
424
high blood levels of phenylalanine (phenylketones are detected in
urine) can lead to mental retardation. Although the PKU test
originally was performed on urine specimens, now it is done by
pricking the newborn's heel to obtain a small blood sample. If
phenylalanine is detected, the infant is fed a diet excluding
phenylalanine. Affected children remain on this diet until adulthood.
10. Bilirubin—A small amount of this pigment substance is present in
urine and gives its distinctive yellow color. Bilirubin is a product of
red blood cell breakdown, and increased levels in urine
(bilirubinuria) are present in patients with liver disease.
425
Pathologic Terminology: Kidney, Bladder,
and Associated Conditions
Kidney
426
glomerulonephritis
interstitial
nephritis
nephrolithiasis
nephrotic
syndrome
(nephrosis)
polycystic kidney
disease (PKD)
pyelonephritis
renal cell
carcinoma
renal failure
renal hypertension
Inflammation of the glomeruli within the kidney.
This condition can follow a streptococcal infection or can be associated
with an autoimmune disease. It results in leaky glomeruli, hematuria,
red blood cell casts, albuminuria, and when severe, renal failure and
uremia. Drugs may be useful to control inflammation, and dialysis or
renal transplantation may be necessary if uremia occurs.
Inflammation of connective tissue that lies between the renal tubules.
Connective, supportive tissue lying between the renal tubules is made
up of renal interstitial cells. Interstitial cells in any organ are found in
addition to the essential, main functional cells, which make up the
parenchyma. The parenchyma in the kidney consists of the glomeruli
and the renal tubules (nephrons). Acute interstitial nephritis, an
increasingly common disorder, may develop after use of NSAIDs
(nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen)
and other drugs. It may be marked by fever, skin rash, and eosinophils
in the blood and urine.
Kidney stones (renal calculi).
Kidney stones usually are composed of uric acid or calcium salts. Stones
often lodge in the ureter or bladder, as well as in the renal pelvis, and
may require removal by lithotripsy (see page 222) or surgery.
Group of clinical signs and symptoms caused by excessive protein
loss in urine.
Nephrotic syndrome may follow glomerulonephritis or exposure to
toxins or certain drugs, immune diseases, and other pathologic
conditions, such as diabetes mellitus and cancer. Two important signs of
nephrotic syndrome are edema (swelling caused by fluid in tissue
spaces) and hypoalbuminemia. Both of these changes are caused by
massive leakage of protein into urine.
Multiple fluid-filled sacs (cysts) within and on the kidney.
There are two types of hereditary PKD. One type usually is
asymptomatic (without symptoms) until middle age and then is marked
by hematuria, urinary tract infections, nephrolithiasis, and renal failure.
The other type of PKD occurs in infants or children and results in renal
failure. Figure 7-12A shows polycystic kidney disease.
Inflammation of the lining of the renal pelvis and renal parenchyma.
The parenchyma of an organ is its essential and distinctive tissue.
Nephrons make up the renal parenchyma. Bacterial infection in the
urinary tract causes collections of pus to form in the kidney, often
associated with bacteria spilling into the bloodstream. Urinalysis reveals
pyuria. Treatment consists of antibiotics and surgical correction of any
obstruction to urine flow.
Cancerous tumor of the kidney in adulthood.
This tumor (see Figure 7-12B) accounts for 2% of all cancers in adults.
Hematuria is the primary abnormal finding, and the tumor often
metastasizes to bones and lungs. Nephrectomy or partial nephrectomy
is the primary treatment.
Decrease in excretion of wastes results from impaired filtration
function.
A large number of conditions, including high blood pressure, infection,
and diabetes, can lead to renal failure, which may be acute (ARF) or
chronic (CRF), reversible or progressive, mild or severe. A newer
classification of chronic kidney disease (CKD) classifies its severity by
the level of creatinine clearance and glomerular filtration rate (GFR),
ranging from normal (stage 1) to end-stage renal failure or ESRF (stage
5), See Spotlight on CKD stages on page 225.
High blood pressure resulting from kidney disease.
Renal hypertension is a type of secondary hypertension (high blood
pressure caused by an abnormal condition such as glomerulonephritis).
However, the most common type of high blood pressure is essential
427
Wilms tumor
hypertension, or primary hypertension. In essential hypertension there
is no obvious underlying medical condition. Chronic essential
hypertension can damage blood vessels, potentially resulting in stroke,
myocardial infarction (heart a ack), heart failure, or renal failure.
Malignant tumor of the kidney occurring in childhood.
This tumor may be treated with surgery, radiation therapy, and
chemotherapy.
FIGURE 7-12 A, Polycystic kidney disease. The kidneys contain
masses of cysts. Typically, polycystic kidneys weigh 20 times more
than their usual weight (150 to 200 grams). B, Renal cell carcinoma.
Urinary Bladder
428
bladder
cancer
Malignant tumor of the urinary bladder.
Bladder cancer occurs more frequently in men (often smokers) and in persons older
than 50 years of age, especially industrial workers exposed to dyes and leathertanning agents. Signs and symptoms include gross (visible to the naked eye) or
microscopic hematuria and dysuria. Cystoscopy with biopsy is the most common
diagnostic procedure. Staging of the tumor is based on the depth to which the tumor
invades the bladder wall and presence of metastasis. Superficial tumors are removed
by electrocauterization (burning). Cystectomy, chemotherapy, and radiation therapy
are treatments for disease that has spread deeply into the bladder wall, to regional
lymph nodes, or to distant organs.
Associated Conditions
diabetes
insipidus
(DI)
diabetes
mellitus
(DM)
Antidiuretic hormone (ADH) is not secreted, or there is a resistance of the
kidney to ADH.
In DI, the kidney produces large amounts of dilute urine (polyuria). Lack of ADH
prevents water from being reabsorbed into the blood through the renal tubules.
Insipidus means tasteless, reflecting very dilute and watery urine, not sweet as in
diabetes mellitus. The term diabetes comes from the Greek diabainein, meaning to
pass through. Both types of diabetes (insipidus and mellitus) are marked by
polyuria and polydipsia.
Insulin is not secreted adequately or tissues are resistant to its effects.
The major signs and symptoms of diabetes mellitus are glycosuria, hyperglycemia,
polyuria, and polydipsia. Without insulin, sugar cannot leave the bloodstream and
is not available to body cells for energy. Sugar remains in the blood
(hyperglycemia) and spills over into the urine (glycosuria). Mellitus means sweet,
reflecting the content of the urine. The term diabetes, when used alone, refers to
diabetes mellitus. See Chapter 18 for more information about diabetes mellitus.
429
Laboratory Tests and Clinical Procedures
Laboratory Tests
BUN
(blood
urea
nitrogen)
creatinine
clearance
Measurement of urea levels in blood.
Normally, the BUN (pronounced be-u-n) level is low because urea is excreted in
the urine continuously. However, when the kidney is diseased or fails, the BUN
may be very high. Urea accumulates in the blood (uremia), leading to
unconsciousness and death.
Measurement of the rate at which creatinine is cleared from the blood by the
kidney.
This is an important test to assess the functioning of the kidney. A blood sample is
drawn and the creatinine concentration in blood is compared with the amount of
creatinine excreted in the urine during a fixed time period. If the kidney is not
functioning well in its job of clearing creatinine from the blood, the amount of
creatinine in the blood will be high relative to the amount in urine. Creatinine
clearance is a useful indicator of the glomerular filtration rate (GFR), which
normally is 90 to 120 mL/minute.
Clinical Procedures
X-Ray Studies
CT urography
KUB
(kidneys,
ureters, and
bladder)
renal
angiography
retrograde
pyelogram (RP)
voiding
cystourethrogram
(VCUG)
X-ray images obtained using computed tomography (CT) show multiple
cross-sectional and other views of the kidney.
CT scanners show multiple views of the kidney, taken with or without
contrast material. Two main indications are to detect kidney stones and to
evaluate patients with hematuria (Figure 7-13A).
X-ray examination (without contrast) of the kidneys, ureters, and
bladder.
A KUB (prounced k-u-be) study demonstrates the size and location of the
kidneys in relation to other organs in the abdominopelvic region. It can
also show kidney stones.
X-ray examination (with contrast) of the blood vessels of the kidney.
This procedure helps diagnose obstruction or constriction of blood vessels
leading to the kidney. The same changes can be seen on CT and MRI
urography.
X-ray image of the renal pelvis and ureters after injection of contrast
through a urinary catheter into the ureters from the bladder.
This technique is useful in locating urinary stones and obstructions.
X-ray image (with contrast) of the urinary bladder and urethra obtained
while the patient is voiding. See Figure 7-13B.
The bladder is filled with contrast material, followed by fluoroscopy (realtime x-ray imaging). Reflux of contrast into the ureters is abnormal and
may occur with recurrent urinary tract infections.
430
FIGURE 7-13 A, CT urography with contrast (axial view) shows a
benign cyst on the kidney. It does not take up the contrast and is
smooth and round. B, Voiding cystourethrogram showing a normal
female urethra. (Courtesy William H. Bush, Jr., MD, University of
Washington, Seattle.)
Ultrasound Examination
ultrasonography
Imaging of urinary tract structures using high-frequency sound waves.
Kidney size, tumors, hydronephrosis, polycystic kidney disease, and
ureteral and bladder obstruction can be diagnosed using ultrasound
techniques.
Radioactive Study
radioisotope
scan
Image of the kidney obtained after injecting a radioactive substance
(radioisotope) into the bloodstream.
Pictures show the size and shape of the kidney (renal scan) and its functioning
(renogram). These studies can indicate narrowing of blood vessels, diagnose
obstruction, and determine the individual functioning of each kidney.
Magnetic Resonance Imaging
MRI
urography
Changing magnetic field produces images of the kidney and surrounding
structures in three planes of the body.
The patient lies within a cylindrical magnetic resonance machine, and images are
made of the pelvic and retroperitoneal regions using magnetic waves. The test
shows tumor invasion of blood vessels, lymph nodes, and adjacent tissues.
Other Procedures
431
cystoscopy
Direct visualization of the urethra and urinary bladder with an endoscope
(cystoscope).
The procedure can be performed in two ways. Flexible cystoscopy uses a
thin fiberoptic cystoscope and is used for diagnosis and check-ups of the
urinary bladder. Rigid cystoscopy uses a hollow metal tube, passed through
the urethra and into the bladder. It is used to take biopsy samples, remove
polyps, or perform laser treatments. Both these tests can be done in the office
or operating room. See Figure 7-14A and B.
dialysis
Process of separating nitrogenous waste materials from the blood.
Dialysis is used to treat acute or chronic renal failure and some cases of drug
use. There are two methods:
1. Hemodialysis (HD) uses an artificial kidney machine that receives wastefilled blood from the patient's bloodstream, filters it through an artificial
porous membrane (dialyzer), and returns the dialyzed blood to the patient's
body (Figure 7-15A). An arteriovenous fistula (communication between an
artery and a vein) is created surgically, often in the patient's arm, to provide
easy access for hemodialysis (Figure 7-15B).
2. Peritoneal dialysis (PD) uses a catheter to introduce fluid into the peritoneal
(abdominal) cavity. Waste materials, such as urea, in the capillaries of the
peritoneum pass out of the bloodstream and into the fluid. The fluid (with
wastes) is then removed by catheter. When used to treat patients with chronic
kidney disease, PD may be performed continuously by the patient without
mechanical support (CAPD—continuous ambulatory PD; Figure 7-16) or with
the aid of a mechanical apparatus used at night during sleep.
lithotripsy
Urinary tract stones are crushed.
The extracorporeal method uses shock waves directed toward the stone
from the outside of the body (extra = outside, corpor/o = body). The patient
receives light sedation or an anesthetic. Stones pass from the body in urine
after the procedure. Abbreviation is ESWL (extracorporeal shock wave
lithotripsy).
renal
Dilation of narrowed areas in renal arteries.
angioplasty
A balloon a ached to a catheter is inserted into the artery and then inflated
to enlarge the vessel diameter. Afterward, stents (metal-mesh tubes) may be
inserted to keep the vessel open. This procedure is used to treat renal
hypertension and to preserve renal function.
renal biopsy
Removal of kidney tissue for microscopic examination.
Biopsy may be performed at the time of surgery (open) or through the skin
(percutaneous, or closed). When the la er technique is used, the patient lies
in the prone position; then, after administration of local anesthesia to the
overlying skin and muscles of the back, the physician inserts a biopsy needle
down into the kidney. Several specimens are obtained for examination by a
pathologist.
renal
Surgical transfer of a kidney from a donor to a recipient.
transplantation
Patients with renal failure may receive a kidney from a living donor, such as
an identical twin (isograft) or other person (allograft), or from a patient at
the time of death (cadaver transplant). Best results occur when the donor is
closely related to the recipient—98% of transplanted kidneys survive for 1
year or longer (Figure 7-17). See the In Person: Kidney Transplant on page
228.
urinary
Passage of a flexible, tubular instrument through the urethra into the
catheterization
urinary bladder.
Catheters are used primarily for short- or long-term drainage of urine. A
Foley catheter is an indwelling (left in the bladder) catheter held in place by
a balloon inflated with liquid (Figure 7-18).
432
FIGURE 7-14 Cystoscopy. A, Rigid cystoscope in place within the
urethra. B, Flexible cystoscope.
FIGURE 7-15 Hemodialysis (HD). A, Patient receiving HD.
Conventional HD involves 3 to 4 hours of dialysis three times weekly.
Newer alternative modalities include slower and longer dialysis,
nocturnal HD, and daily short HD. B, Arteriovenous fistula for
hemodialysis.
433
FIGURE 7-16 Continuous ambulatory peritoneal dialysis (CAPD).
A, The dialysis solution (dialysate) flows from a collapsible plastic bag
through a catheter (Tenckhoff peritoneal catheter) into the patient's
peritoneal cavity. The empty bag is then folded and inserted into
undergarments. B, After 4 to 8 hours, the bag is unfolded, and the fluid
is allowed to drain into it by gravity. The full bag is discarded, and a
new bag of fresh dialysate is attached.
434
FIGURE 7-17 Renal (kidney) transplantation. A, Left kidney of
donor is removed for transplantation. B, Kidney is transplanted to the
right pelvis (iliac fossa) of the recipient. The renal artery and vein of the
donor kidney are joined to the recipient kidney's artery and vein, and
the end of the donor ureter is connected to the recipient's bladder
(ureteroneocystostomy). The health of the donor is not affected by
losing one kidney. In fact, the remaining kidney is able to take over full
function.
FIGURE 7-18 Foley catheter in place in the urinary bladder. The
three-way catheter has three separate lumens: for drainage of urine,
for inflation of balloons in the bladder, and for introduction of irrigating
solutions into the bladder.
Abbreviations
435
ADH
AKI
BUN
CAPD
CKD
antidiuretic hormone—vasopressin
acute kidney (renal) injury
blood urea nitrogen
continuous ambulatory peritoneal dialysis
chronic kidney disease—a condition during which serum creatinine and BUN levels rise,
which may result in impairment of all body systems
−
chloride—an electrolyte excreted by the kidney
Cl
CrCl
creatinine clearance
CRF
chronic renal failure—progressive loss of kidney function; same as CKD
C&S
culture and sensitivity testing—to determine antibiotic effectiveness against bacteria
grown from a patient's urine specimen
cysto cystoscopic examination
eGFR estimated glomerular filtration rate
ESRD end-stage renal disease
ESWL extracorporeal shock wave lithotripsy
HCO3− bicarbonate—an electrolyte conserved by the kidney
HD
hemodialysis
IC
interstitial cystitis—chronic inflammation of the bladder wall; not caused by bacterial
infection and not responsive to conventional antibiotic therapy
IVP
intravenous pyelogram
+
potassium—an electrolyte
K
KUB
kidney, ureters, and bladder
+
sodium—an electrolyte
Na
PD
peritoneal dialysis
pH
potential hydrogen; scale to indicate degree of acidity or alkalinity
PKD
polycystic kidney disease
PUL
percutaneous ultrasound lithotripsy
RP
retrograde pyelography
sp gr specific gravity
UA
urinalysis
UTI
urinary tract infection
VCUG voiding cystourethrogram
CKD Stages
The five stages of CKD reflect increasing severity of kidney disease:
Stage 1: eGFR >90
Stage 2: eGFR 60-90
Stage 3: eGFR 30-60
Stage 4: eGFR 15-30
Stage 5: eGFR <15
Practical Applications
Answers to the questions about the case report and the urinalysis findings
are on page 236.
Urologic Case Report
436
The patient, a 50-year-old woman, presented to the clinic complaining of
painless hematuria and clots in the urine. There had been no history of
urolithiasis, pyuria, or previous hematuria. Nocturia had been present about
5 years earlier. Endoscopy revealed a carcinoma located about 2 cm from the
left ureteral orifice. A metastatic workup was negative. Partial cystectomy
was carried out and the lesion cleared. Bilateral pelvic lymphadenectomy
revealed no positive nodes. No ileal conduit was necessary.
Questions about the Case Report
1. Urologic refers to which system of the body?
a. Digestive
b. Endocrine
c. Excretory
2. What was the patient's reason for appearing at the clinic?
a. Scanty urination
b. Inability to urinate
c. Blood in urine
3. Which of the following was a previous symptom?
a. Excessive urination at night
b. Blood in the urine
c. Pus in the urine
4. What diagnostic procedure was carried out?
a. Lithotripsy
b. Cystoscopy
c. Urinalysis
5. The patient's diagnosis was:
a. Malignant tumor of the bladder
b. Tumor in the proximal ureter
c. Lymph nodes affected by tumor
6. Treatment was:
a. Ureteroileostomy
b. Removal of tumor and subtotal removal of the bladder
c. Not necessary, because of negative lymph nodes
437
Urinalysis Findings
TEST
Color
NORMAL
Amber-yellow
Appearance Clear
pH
4.6-8.0
Protein
None or small
amount
Glucose
None
Ketones
None
Bilirubin
None
Specific
1.003-1.030
gravity
Sediment
None
ABNORMAL
Smoky-red (blood in urine): renal calculi; tumor; kidney disease;
cystitis; urinary obstruction
Cloudy (pyuria): urinary tract infection (UTI)
Alkaline: UTI
Proteinuria: nephritis; renal failure
Glycosuria: diabetes mellitus
Ketonuria: diabetes mellitus
Bilirubinuria: hepatitis or gallbladder disease
High: renal calculi; diabetes mellitus
Low: diabetes insipidus
Casts: nephritis; renal disease
Name the appropriate test for detecting or evaluating each of the
following.
1. Sugar in urine _____________________________________________
2. Level of bile pigment in urine
_____________________________________________
3. Hematuria _____________________________________________
4. Albumin in urine _____________________________________________
5. Structures in the shape of renal tubules in urine
____________________________________
6. Chemical reaction of urine
_____________________________________________
7. Dilution or concentration of urine
_____________________________________________
8. Acetones in urine _____________________________________________
9. Pus in urine _____________________________________________
Urologic Case Study
A 22-year-old woman comes to the ED [emergency department] with a
history of fever, dysuria, and shaking chills. Results of her UA [urinalysis],
with normal findings for comparison, are as follows:
438
TEST
Color
Appearance
Specific gravity
pH
Protein
Glucose
Ketones
Bili
WBC count
Bacteria
Sediment
UA RESULTS
amber-yellow
turbid
1.040
8.4
neg
neg
neg
neg
>100
bacilli (rods)
WBC casts
NORMAL FINDINGS
amber-yellow
clear
1.003-1.030
6.5 (range, 4.6-8.0)
neg
neg
neg
neg
0
0
none
What's the probable diagnosis?
a. Diabetes mellitus with glycosuria
b. Glomerulonephritis with staphylococcal infection
c. Nephrotic syndrome with albuminuria
d. Urinary tract infection with pyelonephritis
In Person
Kidney Transplant
This first-person narrative was wri en by a kidney donor.
When my 64-year-old father-in-law announced to my wife and me that
his kidney function was failing, it didn't really enter our minds that one of
us might ultimately have a part to play in his survival. Five years later,
dialysis was taking its toll on his organ systems, and there had been no
success in obtaining a cadaveric kidney. Things had reached the point
where he needed a kidney in short order, before his health deteriorated to
the point where he would no longer be a candidate for transplantation.
My wife's blood type ruled out the possibility of her being a direct donor,
so I volunteered to be tested. Turns out that her father and I were a match
439
on 5 of the 7 key traits—a really good fit! The next round of testing—blood
work and my kidney function—was able to be done locally. I remember
carrying around a specimen container (on ice), having to provide a full liter
of urine in 24 hours!
The results of those tests were favorable, and two weeks later I made the
-hour drive to the transplant center at the University of Virginia in
Charlo esville. While a transplant is really a team of two—donor and
recipient—the entire process at UVA was very much individualized. A
transplant coordinator (an experienced RN) was assigned specifically to our
case, and I had a team of doctors and support staff dedicated exclusively to
me, the donor. Similarly, there was a team that dealt only with my father-inlaw as the recipient.
My visit involved some more in-depth blood tests and cardiac studies
largely to determine that I was healthy enough for major surgery. My
transplant team and I spent an entire afternoon discussing the implications
of being a donor—the inherent risk in any surgery, potential implications
for me and my family, the likely recovery time, and the possibility that,
despite all of the up-front testing, the transplant might not be successful.
The discussions that afternoon only reaffirmed that I was making the right
decision. I had an opportunity to have a positive impact on someone else's
life, with relatively li le risk to my own health.
The events around the surgery itself were pre y straightforward. The
surgery is a more involved procedure for the donor than for the recipient, so
I was taken back first. A nurse started an IV and injected a mild sedative.
From that point, my only memory is of one last hug for my wife and
children, and then being shifted from the stretcher onto the operating table.
When I woke up in recovery, the news was all good. My surgery had
gone well—four laparoscopic incisions through which the surgeons did
most all of their work, and a lateral incision in my lower abdomen through
which the kidney was removed. Equally important, my father-in-law had
come through his surgery well and the kidney had immediately begun to
function! I was discharged from the hospital on Sunday, and cleared to
return home the next Friday, 8 days post-op.
As is typical following a major surgery, it took about 6 weeks for me to
feel “normal” again. During those 6 weeks, I had weekly blood tests to chart
the progress of my kidney function. I went back to UVA for a routine
follow-up visit at the 6-week mark. I was recovering as expected, and my
remaining kidney was actually growing in size and capacity. Blood tests
continued on a monthly basis until I was officially “discharged” from the
transplant center's care 6 months after the surgery.
Now, 8 years after the transplant, both my father-in-law and I continue to
do well. As my mother-in-law likes to say, I donated a “rock star” kidney
that has allowed our family to enjoy many visits and create many cherished
memories that will last a lifetime. My two children, now 20 and 17, have
enjoyed their grandfather's love and guidance during some very important
years in their lives. This is especially meaningful to me, as I lost my father
440
before my wife and I started our family, and our children missed out on an
opportunity to know and love a wonderful man.
John Melson lives in Greensboro, North Carolina. He is pictured with his fatherin-law, Rod Beckwith.
441
Exercises
Remember to check your answers carefully with the Answers to Exercises,
pages 234 and 235.
A Using the following terms, trace the path of urine from
the renal arterioles (bloodstream) to the point at which
urine leaves the body. The first answer is provided.
glomerular capsule
glomerulus
renal pelvis
renal tubule
ureter
urethra
urinary bladder
urinary meatus
1. glomerulus__________________________
2. ____________________________________
3. ____________________________________
4. ____________________________________
5. ___________________________________
6. ___________________________________
7. ___________________________________
8. ___________________________________
B Match the term in Column I with its definition or a term
of similar meaning in Column II. Write the correct
le er in the spaces provided.
442
COLUMN I
_______
1. voiding
_______
2. trigone
_______
3. renal cortex
4. renal medulla _______
_______
5. urea
6. erythropoietin _______
_______
7. renin
_______
8. electrolyte
_______
9. hilum
_______
10. calyx (calix)
COLUMN II
A. Hormone secreted by the kidney that stimulates formation of red blood cells
B. Notch on the surface of the kidney where blood vessels and nerves enter
C. Urination; micturition
D. Nitrogenous waste
E. Cup-like collecting region of the renal pelvis
F. Small molecule that carries an electric charge in solution
G. Inner region of the kidney
H. Enzyme made by the kidney; increases blood pressure
I. Triangular area in the bladder
J. Outer section of the kidney
C Give the meanings of the following medical terms.
1. caliceal
________________________________________________
______________
2. uric acid
________________________________________________
_______________
3. urinary meatal stenosis
________________________________________________
_____
4. cystocele
________________________________________________
_________________
5. pyelolithotomy
________________________________________________
____________
6. trigonitis
________________________________________________
_________________
7. ureteroileostomy
________________________________________________
___________
8. urethrostenosis
________________________________________________
______________
443
9. vesicoureteral reflux
________________________________________________
_________
10. creatinine
________________________________________________
__________________
11. medullary
________________________________________________
_________________
12. cortical
________________________________________________
___________________
13. calciferol
________________________________________________
__________________
D The following terms all contain the suffix -uria,
meaning urination. Write their meanings in the spaces
provided.
1. nocturia
________________________________________________
_________________
2. dysuria
________________________________________________
____________________
3. oliguria
________________________________________________
__________________
4. polyuria
________________________________________________
_________________
5. anuria
________________________________________________
_____________________
444
E In the following terms, -uria means urine condition
(substance in the urine). What's in the urine?
1. pyuria _________________________
2. albuminuria ___________________
3. hematuria _________________
4. glycosuria _________________
5. ketonuria _____________________
6. bacteriuria ______________________
F Give the meanings of the following terms that relate to
urinary signs and symptoms.
1. azotemia
________________________________________________
______________________
2. polydipsia
________________________________________________
____________
3. urinary incontinence
________________________________________________
__
4. enuresis
________________________________________________
___________
5. urinary retention
________________________________________________
_______
6. ketosis
________________________________________________
_______
G Give short answers for the following.
1. What is the difference between hematuria and uremia?
__________________________
445
2. What is diuresis?
_____________________________________
3. What is a diuretic?
_____________________________________
4. What is antidiuretic hormone?
________________________________
5. What is hyponatremia?
_____________________________________
6. What is hyperkalemia?
___________________________________
7. What is PKU? _________________________________
H Match the listed terms, pertaining to urinalysis, with
their meanings/descriptions that follow.
albuminuria
bilirubinuria
glycosuria
hematuria
ketonuria
pH
pyuria
sediment
specific gravity
1. Abnormal particles present in the urine—cells,
bacteria, casts, and crystals ____________________
2. Smoky-red color of urine caused by the presence of
blood __________________
3. Turbid (cloudy) urine caused by the presence of
polymorphonuclear leukocytes and pus
_______________________
4. Sugar in the urine; a sign of diabetes mellitus and a
result of hyperglycemia _______________________
446
5. Urine test that reflects the acidity or alkalinity of the
urine _____________________
6. High levels of acids and acetones accumulate in the
urine as a result of abnormal fat breakdown
_______________________
7. Dark pigment that accumulates in urine as a result of
liver or gallbladder disease _______________________
8. Urine test that reflects the concentration of the urine
_______________________
9. Leaky glomeruli can produce accumulation of protein
in the urine _________________
I Describe the following abnormal conditions that affect
the kidney.
1. renal failure _______________________
2. polycystic kidney _______________________
3. interstitial nephritis _______________________
4. glomerulonephritis _______________________
5. nephrolithiasis _______________________
6. renal cell carcinoma _______________________
7. pyelonephritis _______________________
8. Wilms tumor _______________________
9. nephrotic syndrome _______________________
10. renal hypertension _______________________
J Match the listed terms with their meanings/descriptions
that follow.
abscess
catheter
diabetes insipidus
diabetes mellitus
edema
447
essential hypertension
nephroptosis
renal colic
secondary hypertension
stricture
1. idiopathic high blood pressure
________________________________
2. swelling, fluid in tissues
______________________________________
3. narrowed area in a tube
__________________________________________
4. collection of pus
__________________________________________
5. inadequate secretion of insulin or improper utilization
of insulin leads to this condition
__________________________________________
6. high blood pressure caused by kidney disease or
another disease
__________________________________________
7. tube for withdrawing or giving fluid
__________________________________________
8. inadequate secretion or resistance of the kidney to the
action of antidiuretic hormone
__________________________________________
9. prolapse of a kidney
_______________________________________
10. severe pain resulting from a stone that is blocking a
ureter or a kidney
__________________________________
K Give the meanings of the abbreviations in Column I.
Then select the le er of the sentence in Column II that
is the best association for each.
448
COLUMN I
1. CAPD
__________________________
2. BUN
__________________________
3. RP
__________________________
4. cysto
__________________________
5. UA
__________________________
6. UTI
__________________________
7. CKD
__________________________
8. K+
__________________________
9. VCUG
__________________________
10. HD
__________________________
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
COLUMN II
A. Bacterial invasion leads to this condition; acute cystitis is an
example.
B. This electrolyte is secreted by renal tubules into the urine.
C. A machine removes nitrogenous wastes from the patient's
blood.
D. High levels measured on this test lead to the suspicion of
renal disease.
E. This endoscopic procedure is used to examine the interior of
the urinary bladder.
F. Dialysate (fluid) is injected into the peritoneal cavity and
then drained out.
G. Contrast is injected into the urinary bladder and ureters and
x-ray pictures of the urinary tract are taken.
H. X-ray pictures of the urinary bladder and urethra are taken
while the patient urinates.
I. Parts of this test include specific gravity, color, protein,
glucose, and pH.
J. This condition includes mild to severe kidney failure.
L Match the listed procedures with their
definitions/meanings that follow.
cystectomy
cystoscopy
cystostomy
lithotripsy
nephrectomy
nephrolithotomy
nephrostomy
ureterolithotomy
urethroplasty
ureteroileostomy
1. Excision of a kidney
_______________________________________
2. Surgical incision into the kidney to remove a stone
_______________________
3. Visual examination of the urinary bladder via
endoscope ________________________
4. Crushing of stones
_______________________________________
449
5. New opening of the ureters to a segment of ileum (in
place of the bladder)
_______________________________________
6. Surgical repair of the urethra
______________________________________
7. Creation of an artificial opening into the kidney (via
catheter) from the outside of the body
_______________________________________
8. Surgical formation of an opening from the bladder to
the outside of the body
_______________________________________
9. Removal of the urinary bladder
_______________________________________
10. Incision of a ureter to remove a stone
_____________________________________
M Circle the correct term to complete the following
sentences.
1. After diagnosis of renal cell carcinoma (made by renal
biopsy), Dr. Davis advised Donna that (nephrostomy,
meatotomy, nephrectomy) would be necessary.
2. Ever since Bill's condition of gout was diagnosed, he
has been warned that uric acid crystals could
accumulate in his blood and tissues, leading to
(pyuria, renal calculi, cystocele).
3. The voiding cystourethrogram demonstrated blockage
of urine flow from Jim's bladder and (hydronephrosis,
renal ischemia, azotemia).
4. Narrowed arterioles in the kidney increase blood
pressure, so (urinary incontinence, urinary retention,
nephrosclerosis) is often associated with
hypertension.
5. Eight-year-old Willy continually wet his bed at night
while sleeping. His pediatrician instructed his mother
450
to limit Willy's intake of fluids in the evening to
discourage his (nocturia, oliguria, enuresis).
6. David's chronic type 1 diabetes eventually resulted in
(nephropathy, meatal stenosis, urolithiasis), which
led to renal failure.
7. After Sue's bilateral renal failure, her doctor advised
dialysis and possible (cystostomy, nephrolithotomy,
renal transplantation).
8. When Maria's left kidney stopped functioning, her
contralateral kidney overdeveloped or (metastasized,
atrophied, hypertrophied) to meet the increased
workload.
9. A popular diet program recommends eating foods
high in fats and protein. People on this diet check their
urine for the presence of (ketones, glucose, amino
acids).
10. Andrea's urinalysis revealed proteinuria, and her
ankles began to swell, demonstrating pi ing, a
condition known as (ascites, edema, stricture). Her
(gastroenterologist, urologist, nephrologist)
diagnosed Andrea's condition as (polycystic kidneys,
nephrotic syndrome, bladder carcinoma) and
recommended drugs to heal leaky glomeruli and
diuretics to reduce swelling.
451
Answers to Exercises
A
1. glomerulus
2. glomerular capsule
3. renal tubule
4. renal pelvis
5. ureter
6. urinary bladder
7. urethra
8. urinary meatus
B
1. C
2. I
3. J
4. G
5. D
6. A
7. H
8. F
9. B
10. E
C
1. pertaining to a calix (collecting cup of renal pelvis)
452
2. nitrogenous waste excreted in urine; high levels of uric
acid in the blood are associated with gouty arthritis
3. narrowing of the urinary meatus
4. hernia of the urinary bladder
5. incision to remove a stone from the renal pelvis
6. inflammation of the trigone (triangular area in the
bladder in which the ureters enter and urethra exits)
7. new opening between the ureter and the ileum (an
anastomosis); urine then leaves the body through an
ileostomy; this surgery (ileal conduit) is performed when
the bladder has been removed
8. narrowing (narrowed portion) of the urethra
9. backflow of urine from the bladder into the ureter
10. nitrogenous waste produced as a result of muscle
metabolism and excreted in the urine
11. pertaining to the inner, middle section (of the kidney)
12. pertaining to the outer section (of the kidney)
13. active form of vitamin D secreted by the kidneys
D
1. frequent urination at night
2. painful urination
3. scanty urination
4. excessive urination
5. no urination
E
1. pus
453
2. protein
3. blood
4. sugar
5. ketones or acetones
6. bacteria
F
1. excess nitrogenous waste in the bloodstream
2. condition of much thirst
3. inability to hold urine in the bladder
4. bedwe ing
5. inability to release urine from the bladder
6. abnormal condition of ketone bodies (acids and acetones)
in the blood and body tissues
G
1. Hematuria is the presence of blood in the urine, and
uremia is a toxic condition of excess urea (nitrogenous
waste) in the bloodstream. Hematuria is a symptomatic
condition of the urine (-uria), and uremia is an abnormal
condition of the blood (-emia).
2. Diuresis is the excessive production of urine (polyuria).
3. A diuretic is a drug or chemical (caffeine or alcohol) that
causes diuresis to occur.
4. Antidiuretic hormone is a hormone produced by the
pituitary gland that normally helps the renal tubules to
reabsorb water back into the bloodstream. It works
against diuresis to help retain water in the blood.
454
5. Hyponatremia is abnormally low levels of sodium in the
bloodstream.
6. Hyperkalemia is abnormally high concentration of
potassium in the blood. The major cause is chronic renal
failure.
7. PKU is phenylketonuria. This occurs when there are high
levels of phenylketones in urine and phenylalanine in the
blood. The condition causes mental retardation in
infants.
H
1. sediment
2. hematuria (blood in the urine)
3. pyuria (pus in the urine)
4. glycosuria (sugar in the urine)
5. pH
6. ketonuria (ketone bodies in the urine)
7. bilirubinuria (high levels of bilirubin in the urine)
8. specific gravity
9. albuminuria
I
1. kidney does not excrete wastes
2. multiple fluid-filled sacs form in and on the kidney
3. inflammation of the connective tissue (interstitium) lying
between the renal tubules
4. inflammation of the glomerulus of the kidney (may be a
complication after a streptococcal infection)
5. condition of kidney stones (renal calculi)
455
6. malignant tumor of the kidney in adults
7. inflammation of the renal pelvis and parenchyma of the
kidney (caused by a bacterial infection, such as with
Escherichia coli, that spreads to the urinary tract from the
gastrointestinal tract)
8. malignant tumor of the kidney in children
9. group of symptoms (proteinuria, edema,
hypoalbuminemia) that appears when the kidney is
damaged by disease; also called nephrosis
10. high blood pressure caused by kidney disease
J
1. essential hypertension
2. edema
3. stricture
4. abscess
5. diabetes mellitus
6. secondary hypertension
7. catheter
8. diabetes insipidus
9. nephroptosis
10. renal colic
K
1. continuous ambulatory peritoneal dialysis: F
2. blood urea nitrogen: D
3. retrograde pyelogram: G
4. cystoscopy: E
456
5. urinalysis: I
6. urinary tract infection: A
7. chronic kidney disease: J
8. potassium: B
9. voiding cystourethrogram: H
10. hemodialysis: C
L
1. nephrectomy
2. nephrolithotomy
3. cystoscopy
4. lithotripsy
5. ureteroileostomy
6. urethroplasty
7. nephrostomy
8. cystostomy
9. cystectomy
10. ureterolithotomy
M
1. nephrectomy
2. renal calculi—don't confuse a calculus (stone) with dental
calculus, which is an accumulation of dental plaque that
has hardened
3. hydronephrosis
4. nephrosclerosis
5. enuresis
457
6. nephropathy
7. renal transplantation
8. hypertrophied
9. ketones
10. edema, nephrologist, nephrotic syndrome
Answers to Practical Applications
Urologic Case Report
1. c
2. c
3. a
4. b
5. a
6. b
Urinalysis Findings
1. glucose
2. bilirubin
3. color
4. protein
5. sediment
6. pH
7. specific gravity
8. ketones
9. appearance
Urologic Case Study
Correct diagnosis is d.
458
Pronunciation of Terms
The terms you have learned in this chapter are presented here with their
pronunciations. The meanings for all the terms are in the Mini-Dictionary
beginning on page 897. You can also hear each term pronounced on the
Evolve website (h p://evolve.elsevier.com/Chabner/language/).
459
TERM
acetone
albuminuria
antidiuretic hormone
anuria
arteriole
azotemia
bacteriuria
BUN
calciferol
caliceal
caliectasis
calyx; pl. calyces
catheter
cortex
cortical
creatinine
creatinine clearance
CT urography
cystectomy
cystitis
cystoscopy
cystostomy
diabetes insipidus
diabetes mellitus
diuresis
dysuria
edema
electrolyte
enuresis
erythropoietin
essential hypertension
filtration
glomerular capsule
glomerulonephritis
glomerulus; pl. glomeruli
glycosuria
hematuria
hemodialysis
hilum
hydronephrosis
hyperkalemia
hypernatremia
interstitial nephritis
intravesical
ketonuria
ketosis
kidney
KUB
lithotripsy
meatal stenosis
meatus
medulla
medullary
MRI urography
nephrolithiasis
PRONUNCIATION
AS-eh-tohn
al-bu-min-U-re-ah
an-tih-di-u-RET-ik HOR-mohn
an-U-re-ah
ar-TE-re-ohl
az-o-TE-me-ah
bak-te-re-U-re-ah
B-U-N
kal-SIF-er-ol
ka-lih-SE-al
ka-le-EK-tah-sis
KA-liks; KA-lih-seez
KATH-et-er
KOR-teks
KOR-tik-al
kre-AH-tih-neen
kre-AH-tih-neen KLE-ranz
CT u-ROG-rah-fe
sis-TEK-to-me
sis-TI-tis
sis-TOS-ko-pe
sis-TOS-to-me
di-ah-BE-teez in-SIP-ih-dus
di-ah-BE-teez MEL-ih-tus
di-u-RE-sis
dis-U-re-a
eh-DE-mah
eh-LEK-tro-lite
en-u-RE-sis
eh-rith-ro-PO-eh-tin
e-SEN-shul hi-per-TEN-shun
fil-TRA-shun
glo-MER-u-lar KAP-sul
glo-mer-u-lo-nef-RI-tis
glo-MER-u-lus; glo-MER-u-li
gli-kohs-U-re-ah
hem-ah-TU-re-ah
he-mo-di-AL-ih-sis
HI-lum
hi-dro-neh-FRO-sis
hi-per-ka-LE-me-ah
hi-per-na-TRE-me-ah
in-ter-STIH-shul neh-FRI-tis
in-trah-VES-ih-kal
ke-to-NU-re-ah
ke-TO-sis
KID-ne
K-U-B
LITH-o-trip-se
me-A-tal sten-O-sis
me-A-tus
meh-DU-lah
MED-u-lah-re
MRI u-ROG-raf-e
neh-fro-lih-THI-ah-sis
460
TERM
nephrolithotomy
nephron
nephropathy
nephroptosis
nephrostomy
nephrotic syndrome
nitrogenous waste
nocturia
oliguria
paranephric
parenchyma
peritoneal dialysis
phenylketonuria
polycystic kidney disease
polydipsia
polyuria
potassium
pyelolithotomy
pyelonephritis
pyuria
reabsorption
renal angiography
renal angioplasty
renal artery
renal calculi
renal cell carcinoma
renal colic
renal failure
renal hypertension
renal ischemia
renal pelvis
renal transplantation
renal tubule
renal vein
renin
retrograde pyelogram
secondary hypertension
sodium
stricture
trigone
trigonitis
urea
uremia
ureter
ureteroileostomy
ureteroneocystostomy
ureteroplasty
urethra
urethral stricture
urethritis
urethroplasty
uric acid
urinalysis
urinary bladder
urinary catherization
PRONUNCIATION
neh-fro-lih-THOT-o-me
NEH-fron
neh-FROP-ah-the
neh-FROP-to-sis
neh-FROS-to-me
neh-FROT-ik sin-drome
ni-TROJ-en-us waste
nok-TU-re-ah
ol-ig-U-re-ah
par-ah-NEF-rik
pah-RENK-ih-mah
per-it-o-NE-al di-AL-ih-sis
fe-nil-ke-to-NU-re-ah
pol-e-SIS-tik KID-ne dih-ZEEZ
pol-e-DIP-se-ah
pol-e-U-re-ah
po-TAS-e-um
pi-el-o-lith-OT-o-me
pi-el-o-neh-FRI-tis
pi-U-re-ah
re-ab-SORP-shun
RE-nal an-je-OG-rah-fe
RE-nal AN-je-o-plas-te
RE-nal AR-teh-re
RE-nal KAL-ku-li
RE-nal sel kar-sih-NO-mah
RE-nal KOL-ik
RE-nal FA-lyur
RE-nal hi-per-TEN-shun
RE-nal is-KE-me-ah
RE-nal PEL-vis
RE-nal trans-plan-TA-shun
RE-nal TU-bule
RE-nal vayn
RE-nin
RET-ro-grade PI-el-o-gram
SEK-on-dah-re hi-per-TEN-shun
SO-de-um
STRIK-shur
TRI-gohn
tri-go-NI-tis
u-RE-ah
u-RE-me-ah
U-reh-ter
u-re-ter-o-il-OS-to-me
u-re-ter-o-ne-o-sis-TOS-to-me
u-re-ter-o-PLAS-te
u-RE-thrah
u-RE-thral STRIK-shur
u-re-THRI-tis
u-re-thro-PLAS-te
U-rik acid
u-rin-AL-ih-sis
U-rin-ar-e BLAD-er
U-rin-ar-e kath-et-er-ih-ZA-shun
461
TERM
urinary incontinence
urinary retention
urination
vesicoureteral reflux
voiding
voiding cystourethrogram
Wilms tumor
PRONUNCIATION
U-rin-ar-e in-KON-tin-en
U-rin-ar-e re-TEN-shun
u-rin-A-shun
ves-ik-o-u-RE-ter-al RE-fluks
VOY-ding
VOY-ding sis-to-u-RE-thro-gram
wilmz TU-mur
Review Sheet
Write the meanings of the combining forms, suffixes, and prefixes in the
spaces provided. Check your answers with the information in the chapter or
in the Glossary (Medical Word Parts—English) at the end of this book.
Combining Forms
COMBINING FORM
albumin/o
angi/o
azot/o
bacteri/o
cali/o
calic/o
cyst/o
dips/o
glomerul/o
glycos/o
hydr/o
isch/o
kal/i
ket/o
keton/o
lith/o
MEANING
COMBINING FORM
____________________ meat/o
____________________ natr/o
____________________ necr/o
____________________ nephr/o
____________________ noct/o
____________________ olig/o
____________________ py/o
____________________ pyel/o
____________________ ren/o
____________________ trigon/o
____________________ ur/o
____________________ ureter/o
____________________ urethr/o
____________________ urin/o
____________________ vesic/o
____________________
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Suffixes
SUFFIX
-ectasis
-ectomy
-emia
-esis
-gram
-lithiasis
-lithotomy
-lysis
-megaly
-ole
-osis
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
SUFFIX
-pathy
-plasty
-poietin
-ptosis
-rrhea
-sclerosis
-stenosis
-stomy
-tomy
-tripsy
-uria
Prefixes
462
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
PREFIX
a-, anantidiadysen-
MEANING
____________________
____________________
____________________
____________________
____________________
PREFIX
hypoperipolyretro-
MEANING
____________________
____________________
____________________
____________________
Anatomic Terms
Match the locations/functions in Column I with the urinary system
structures in Column II. Write the number of the correct structure in the
blanks provided.
COLUMN I
Tiny structure surrounding each glomerulus; receives filtered materials
from blood.
Tubes carrying urine from kidney to urinary bladder.
Tubules leading from the glomerular capsule. Urine is formed there as
water, sugar, and salts are reabsorbed into the bloodstream.
Inner (middle) region of the kidney.
Muscular sac that serves as a reservoir for urine.
Cup-like divisions of the renal pelvis that receive urine from the renal
tubules.
Tube carrying urine from the bladder to the outside of the body.
Central urine-collecting basin in the kidney that narrows into the ureter.
Collection of capillaries through which materials from the blood are
filtered into the glomerular capsule.
Outer region of the kidney.
COLUMN II
______ 1. urethra
2. cortex
______ 3. glomerular
capsule
______
4. calices
5. renal
______
pelvis
______ 6.
______
glomerulu
s
______ 7. medulla
8. renal
______
tubules
______ 9. urinary
bladder
______ 10. ureters
Give the medical terms for the following conditions related to urine or
substances in urine.
1. sugar in urine _____________________________________________
2. protein in urine _____________________________________________
3. painful urination _____________________________________________
4. scanty urination _____________________________________________
5. bacteria in urine _____________________________________________
6. excessive urination _____________________________________________
7. blood in urine _____________________________________________
8. ketones in urine _____________________________________________
9. absence of urination _______________________________________
10. pus in urine _____________________________________________
11. excessive urination at night _____________________________
463
CHAPTER 8
464
Female Reproductive System
CHAPTER SECTIONS:
Introduction 242
Organs of the Female Reproductive System 242
Menstruation and Pregnancy 246
Vocabulary 250
Terminology 252
Pathology: Gynecologic, Breast, Pregnancy, and Neonatal
258
Clinical Tests and Procedures 266
Abbreviations 272
Practical Applications 273
In Person: Prophylactic Mastectomy 275
Exercises 276
Answers to Exercises 284
Pronunciation of Terms 286
Review Sheet 289
CHAPTER GOALS
• Name and locate female reproductive organs and learn their combining
forms.
• Explain how these organs and their hormones function in the normal
processes of ovulation, menstruation, and pregnancy.
• Identify abnormal conditions of the female reproductive system and of the
newborn.
465
• Describe important laboratory tests and clinical procedures used in
gynecology and obstetrics, and recognize related abbreviations.
• Apply your new knowledge to understanding medical terms in their proper
contexts, such as medical reports and records.
466
Introduction
Sexual reproduction is the union of the ovum (female sex cell) and the
sperm (male sex cell). Each sex cell, known as a gamete, has half the
number of chromosomes needed to create a new organism. In
fertilization, nuclei of the two gametes unite to form a single nucleus
with half of the chromosomes and genetic code from each parent.
Special organs called gonads in males and females produce the egg
and sperm cells. The female gonads are the ovaries, and the male
gonads are the testes. After an ovum leaves the ovary during ovulation,
it travels down one of two fallopian tubes leading to the uterus
(womb). If coitus (copulation, sexual intercourse) has occurred, millions
of sperm cells travel into the fallopian tubes, but only one sperm cell can
penetrate the ovum. This is fertilization. The fertilized ovum is then
known as a zygote. After many cell divisions, a ball of cells forms, and
the zygote is called an embryo (2 to 8 weeks) and finally a fetus (8 to 38
or 40 weeks). The period of development within the uterus is gestation,
or pregnancy.
The female reproductive system consists of organs that produce ova
(singular; ovum) and provide a place for the growth of the embryo. In
addition, the female reproductive organs supply important hormones
that contribute to the development of female secondary sex
characteristics (body hair, breast development, structural changes in
bones and fat).
The eggs, or ova, are present from birth in the female ovary but begin
to mature and are released from the ovary in a 21- to 28-day cycle when
secondary sex characteristics develop. The occurrence of the first cycle is
called menarche. Menstrual cycles continue until menopause, when all
eggs have been released, hormone production diminishes, and
menstruation ends. If fertilization occurs during the years between
menarche and menopause, the fertilized egg may grow and develop
within the uterus. A new, blood vessel–rich organ called a placenta
(connected to the embryo by the umbilical cord) develops to nourish the
embryo, which implants in the uterine lining. Various hormones are
secreted from the ovary and from the placenta to stimulate the
expansion of the placenta. If fertilization does not occur, hormonal
changes result in the shedding of the uterine lining, and bleeding, or
menstruation, occurs.
The hormones of the ovaries, estrogen and progesterone, play
important roles in the processes of menstruation and pregnancy, and in
the development of secondary sex characteristics. The pituitary gland,
467
located at the base of the brain, secretes other hormones that govern the
reproductive functions of the ovaries, breasts, and uterus.
Gynecology is the study of the female reproductive system (organs,
hormones, and diseases); obstetrics (Latin obstetrix means midwife) is a
specialty concerned with pregnancy and the delivery of the fetus; and
neonatology is the study of the care and treatment of the newborn.
468
Organs of the Female Reproductive
System
Uterus, Ovaries, and Associated Organs
Label Figures 8-1 and 8-3 as you read the following description of the
female reproductive system.
FIGURE 8-1 Organs of the female reproductive system,
lateral view.
Figure 8-1 shows a side view of the female reproductive organs and
their relationship to other organs in the pelvic cavity. The ovaries [1]
(only one ovary is shown in this lateral view) are a pair of small
almond-shaped organs located in the pelvis. The fallopian tubes [2]
(only one is shown in this view) lead from each ovary to the uterus [3],
which is a fibromuscular organ situated between the urinary bladder
and the rectum. The uterus normally is the size and shape of a pear and
is about 3 to 4 inches long in a nonpregnant woman. Midway between
the uterus and the rectum is a region in the abdominal cavity known as
the cul-de-sac [4].
The vagina [5], a tubular structure, extends from the uterus to the
exterior of the body. Bartholin glands [6] are two small, rounded
glands on either side of the vaginal orifice. These glands produce a
469
mucous secretion that lubricates the vagina. The clitoris [7] is an organ
of sensitive, erectile tissue located anterior to the vaginal orifice
(opening) and in front of the urethral orifice. The region between the
vaginal orifice and the anus is the perineum [8].
The external genitalia of the female are collectively called the vulva.
Figure 8-2 shows the various structures that are part of the vulva. The
labia majora, the outer lips of the vagina, surround the smaller, inner
lips, the labia minora. The hymen, a thin membrane partially covering
the entrance to the vagina, is broken apart during the first episode of
intercourse. The clitoris and Bartholin glands also are parts of the vulva.
FIGURE 8-2 Female external genitalia (vulva). The mons
pubis (Latin mons, mountain) is a pad of tissue overlying the
pubic symphysis. After puberty it is covered with pubic hair.
Figure 8-3 shows an anterior view of the female reproductive system.
Each ovary [1] is held in place on either side of the uterus by a uteroovarian ligament [2].
470
FIGURE 8-3 Organs of the female reproductive system,
anterior view.
Within each ovary are thousands of small sacs—the ovarian follicles
[3]. Each follicle contains an ovum [4]. During ovulation, an ovum
matures; its follicle ruptures through the surface and releases the ovum
from the ovary. A ruptured follicle fills with a yellow, fat-like material.
It is then called the corpus luteum [5], meaning yellow body. The
corpus luteum secretes hormones (both estrogen and progesterone) that
maintain the very first stages of pregnancy.
A fallopian tube [6] is about
inches long and lies near each ovary.
Collectively, the fallopian tubes, ovaries, and supporting ligaments are
the adnexa (accessory structures) of the uterus. The finger-like ends of
the fallopian tube are the fimbriae [7]. They catch the egg after its
release from the ovary. Cilia (small hairs) line the fallopian tube and,
through their motion, sweep the ovum toward the uterus. It usually
takes the ovum about 2 to 3 days to pass through the fallopian tube.
If sperm cells are present in the fallopian tube, fertilization may occur
(Figure 8-4). If sperm cells are not present, the ovum remains
unfertilized and eventually disintegrates.
471
FIGURE 8-4 Fertilization. A, Once a single sperm cell has
penetrated the ovum, others are prevented from entering. B,
Electromicrograph showing a sperm cell penetrating an ovum.
The fallopian tubes, one on each side, lead into the uterus [8], a pearshaped organ with muscular walls and a mucous membrane lining
filled with a rich supply of blood vessels. The rounded upper portion of
the uterus is the fundus, and the larger, central section is the corpus
(body of the organ). The inner layer, a specialized epithelial mucosa of
the uterus is the endometrium [9]; the middle, muscular layer of the
uterine wall is the myometrium [10]; and the outer, membranous tissue
layer is the perimetrium (uterine serosa) [11], a lining that produces a
watery, serum-like secretion. The outermost layer of an organ in the
abdomen or thorax is also known as a serosa.
The narrow, lowermost portion of the uterus is the cervix [12] (Latin
cervix means neck). The cervical opening leads into a 3-inch-long
muscular, mucosa-lined canal called the vagina [13], which opens to the
outside of the body.
The Breast (Accessory Organ of Reproduction)
Label Figure 8-5 as you read the following description of breast
structures.
472
FIGURE 8-5 Views of the breast. A, Sagittal. B, Frontal. Notice
the numerous lymph nodes.
The breasts, located on the upper anterior region of the chest, are
composed mostly of mammary glands. The glandular tissue [1]
contains milk glands that develop in response to hormones from the
ovaries during puberty. The breasts also contain fibrous and fa y tissue
[2], special lactiferous (milk-carrying) ducts [3], and sinuses (cavities)
[4] that carry milk to the nipple, which has small openings for the ducts
to release their milk. The breast nipple is the mammary papilla [5], and
the dark pigmented area around the mammary papilla is the areola [6].
During pregnancy the hormones from the ovaries and the placenta
stimulate glandular and other tissues in the breasts to their full
development. After parturition (giving birth), hormones from the
pituitary gland stimulate the normal secretion of milk (lactation).
473
Menstruation and Pregnancy
Menstrual Cycle (Figure 8-6)
Menarche, or onset of menstruation with the first menstrual cycle,
occurs at the time of puberty. An average menstrual cycle lasts for 28
days but may be shorter or longer, and cycles may be irregular in
length. These days can be divided into four time periods, useful in
describing the events of the cycle. The approximate time periods are as
follows:
FIGURE 8-6 The menstrual cycle. Tip: Don't try to memorize
this figure. Just get the big picture! In the ovary, as the ovum
matures, hormone levels rise, culminating in ovulation (days 13
and 14). At the same time, in the uterus, the endometrium is
building up in anticipation of pregnancy. If pregnancy does not
occur, hormone levels drop and menstruation begins.
Days 1 to 5 (menstrual period)
Discharge of bloody fluid containing disintegrated endometrial
cells, glandular secretions, and blood cells.
Days 6 to 12
After bleeding ceases, the endometrium begins to repair itself.
The maturing follicle in the ovary releases estrogen, which aids
in the repair. The ovum grows in the follicle during this period.
Days 13 and 14 (ovulatory period)
On about the 14th day of the cycle, the follicle ruptures and the
egg leaves the ovary (ovulation), passing through the fallopian
tube.
474
Days 15 to 28
The empty follicle that has just released the egg becomes a
corpus luteum (Latin for yellow body because of its color). The
corpus luteum functions as an endocrine organ, continuing to
make estrogen and now secreting the hormone progesterone into
the bloodstream. Progesterone stimulates the endometrial
buildup in anticipation of fertilization of the egg and pregnancy.
If fertilization does not occur, the corpus luteum in the ovary
stops producing progesterone and regresses. At this time,
lowered levels of progesterone and estrogen probably are
responsible for some women's symptoms of depression, breast
tenderness, and irritability before menstruation. The combination
of these symptoms is known as premenstrual syndrome (PMS).
After 2 days of decrease in hormones, the uterine endometrium
breaks down, and the menstrual period begins (days 1 to 5).
Note: Cycles vary in length, ranging from 21 to 42 days or longer.
Ovulation typically occurs 14 days before the end of the cycle. A
woman with a 42-day cycle ovulates on day 28, whereas a
woman with a 21-day cycle ovulates on day 7.
Pregnancy
If fertilization does occur in the fallopian tube, the fertilized egg travels
to the uterus and implants in the uterine endometrium. The corpus
luteum in the ovary continues to produce progesterone and estrogen.
These hormones support the vascular and glandular development of the
uterine lining.
The placenta, a vascular organ, now forms, a ached to the uterine
wall. The placenta is derived from maternal endometrium and from the
chorion, the outermost membrane that surrounds the developing
embryo. The amnion, the innermost of the embryonic membranes,
holds the fetus suspended in an amniotic cavity surrounded by a fluid
called the amniotic fluid. The amnion with its fluid also is known as the
“bag of waters” or amniotic sac, which ruptures (breaks) during labor.
The maternal blood and the fetal blood never mix during pregnancy,
but important nutrients, oxygen, and wastes are exchanged as the blood
vessels of the fetus (coming from the umbilical cord) lie side by side
with the mother's blood vessels in the placenta. Figure 8-7A and B
shows implantation in the uterus and the embryo's relationship to the
placenta and enveloping membranes (chorion and amnion).
475
FIGURE 8-7 A, Implantation of the embryo in the
endometrium. B, The placenta, with chorion and amnion
membranes.
As the placenta develops, it produces its own hormone, human
chorionic gonadotropin (hCG). When women test their urine with a
pregnancy test kit, presence or absence of hCG confirms or rules out
that they are pregnant. This hormone stimulates the corpus luteum to
continue producing hormones until about the third month of
pregnancy, when the placenta takes over the endocrine function and
releases estrogen and progesterone. Progesterone maintains the
development of the placenta. Low levels of progesterone can lead to
spontaneous abortion in pregnant women and menstrual irregularities
in nonpregnant women.
The uterus normally lies within the pelvis. During pregnancy the
uterus expands as the fetus grows, and the superior part rises out of the
pelvic cavity to become an abdominal organ. By about 28 to 30 weeks, it
occupies a large part of the abdominopelvic cavity and reaches the
epigastric region (Figure 8-8).
476
FIGURE 8-8 The growing uterus changes the pelvic
anatomy during pregnancy, as shown here in sagittal section:
A, nonpregnant woman, B, 20 weeks pregnant, C, 30 weeks
pregnant.
The onset of true labor is marked by rhythmic contractions, dilation
and thinning (effacement) of the cervix, and a discharge of bloody
mucus from the cervix and vagina (the “show”). In a normal delivery
position, the baby's head appears first (cephalic presentation). After
vaginal delivery of the baby, the umbilical cord is cut and the placenta
follows (Figure 8-9). Figure 8-10A and B shows photographs of a
newborn and the placenta with a ached cord, minutes after birth. The
expelled placenta is the afterbirth.
477
FIGURE 8-9 A, Cephalic presentation (“crowning”) of the fetus
during delivery from the vaginal (birth) canal. B, Usually within 15
minutes after parturition (birth), the placenta separates from the
uterine wall. Forceful contractions expel the placenta and
attached membranes, now called the afterbirth. The three
phases of labor are (1) dilation of the cervix, (2) expulsion or birth
of the infant, and (3) delivery of the placenta.
FIGURE 8-10 A, My newborn granddaughter, Beatrix Bess
(Bebe) Thompson, and her mother, Dr. Elizabeth Chabner
Thompson, minutes after Bebe's birth. Notice that Bebe's skin is
covered with vernix caseosa, a mixture of a fatty secretion from
fetal sebaceous (oil) glands and dead skin. The vernix protects
the fetus's delicate skin from abrasions, chapping, and hardening
as a result of being bathed in amniotic fluid. B, The placenta and
umbilical cord just after expulsion from the uterus.
Hormonal Interactions
478
The events of menstruation and pregnancy depend on hormones not
only from the ovaries (estrogen and progesterone) but also from the
pituitary gland. The pituitary gland secretes follicle-stimulating
hormone (FSH) and luteinizing hormone (LH) after the onset of
menstruation. As their levels rise in the bloodstream, FSH and LH
stimulate maturation of the ovum and ovulation. The spike in LH levels
is called the LH surge. This triggers ovulation and the development of
the corpus luteum. The surge can last for a few hours or a few days, and
ovulation usually occurs 24 hours after its onset. Home ovulation kits
track LH levels in urine. After ovulation, LH influences the maintenance
of the corpus luteum and its production of estrogen and progesterone.
During pregnancy, the high levels of estrogen and progesterone from
the ovary and placenta cause the pituitary gland to stop producing FSH
and LH. Therefore, while a woman is pregnant, additional eggs do not
mature and ovulation cannot occur. Oral contraceptives (birth control
pills) work in the same way.
Another female birth control method is an IUD (intrauterine device).
A health care professional inserts the IUD, a small device designed to
remain inside the uterus. It works by preventing implantation of the
embryo. Birth control pills and an IUD do not protect a woman against
sexually transmi ed infections such as that caused by HIV. See page 274
for a table of contraceptive choices and their features.
How Do Birth Control Pills Work?
Birth control pills contain a combination of estrogen and progesterone
or progesterone only. When taken as directed, they increase the levels
of these hormones in the woman's bloodstream. High levels of estrogen
and progesterone send a signal to the pituitary gland to shut down its
secretion of follicle-stimulating hormone (FSH) and luteinizing
hormone (LH). When these hormones are blocked, the ovaries will not
release eggs, and pregnancy cannot occur. During pregnancy, levels of
estrogen and progesterone also are high—and the ovaries will not
release eggs then either! So birth control pills effectively fool the body
into “thinking” that the woman is pregnant, and her ovaries stop
producing eggs.
When all of the ova are released and secretion of estrogen from the
ovaries lessens, menopause begins. Menopause signals the gradual
ending of menstrual cycles. Premature menopause occurs before age 40,
whereas delayed menopause occurs after age 55. Artificial menopause
479
occurs if the ovaries are removed by surgery or made nonfunctional as a
result of radiation therapy or some forms of chemotherapy.
During menopause, when estrogen levels fall, the most common signs
and symptoms are hot flashes (temperature regulation in the brain is
disturbed), insomnia, and vaginal atrophy (lining of the vagina dries
and thins, predisposing the affected woman to irritation and discomfort
during sexual intercourse). Hormone replacement therapy (HRT),
given orally or as a transdermal patch or vaginal ring, relieves these
symptoms of menopause and delays the development of weak bones
(osteoporosis). HRT use may be associated with an increased risk of
breast cancer, endometrial cancer, stroke, or heart a ack. This therapy
should be used only after careful consideration of potential risks and
benefits.
Table 8-1 reviews the various female hormones, including the sites
where they are produced, their target organs, and their effect on the
body.
TABLE 8-1
FEMALE HORMONES
PRODUCTION
SITE(S)
FSH
Pituitary gland
LH
Pituitary gland
Estrogen
Ovary
Placenta (during
pregnancy)
Progesterone
Ovary (corpus
luteum)
Placenta (during
pregnancy)
hCG
Placenta
HORMONE
TARGET
ORGAN
Ovary
Ovary
Uterus
Uterus
EFFECT
Stimulates maturation of the ovum
Stimulates ovulation
Builds up the endometrial lining
Sustains uterine lining and placenta
during pregnancy
Ovary (corpus Sustains pregnancy
luteum)
FSH, follicle-stimulating hormone; hCG, human chorionic gonadotropin; LH, luteinizing
hormone.
Vocabulary
The following list reviews many of the new terms introduced in the
text. Short definitions reinforce your understanding of the terms.
480
adnexa uteri
amnion
areola
Bartholin
glands
Fallopian tubes, ovaries, and supporting ligaments.
Innermost membrane surrounding the embryo and fetus.
Dark-pigmented area surrounding the breast nipple.
Small mucus-secreting exocrine glands at the vaginal orifice (opening to
outside of the body). Caspar Bartholin was a Danish anatomist who
described the glands in 1637.
cervix
Lower, neck-like portion of the uterus.
chorion
Outermost membrane surrounding the embryo and fetus; it forms the fetal
part of the placenta.
clitoris
Organ of sensitive erectile tissue anterior to the opening of the female
urethra.
coitus
Sexual intercourse; copulation. Pronunciation is KO-ih-tus.
corpus
Empty ovarian follicle that secretes progesterone after release of the egg cell;
luteum
literally means yellow (luteum) body (corpus).
cul-de-sac
Region in the lower abdomen, midway between the rectum and the uterus.
embryo
Stage in prenatal development from 2 to 8 weeks.
endometrium Inner, mucous membrane lining of the uterus.
estrogen
Hormone produced by the ovaries; promotes female secondary sex
characteristics.
fallopian
One of a pair of ducts through which the ovum travels to the uterus; also
tube
called an oviduct. The tubes were named for Gabriello Fallopia, an Italian
anatomist.
fertilization Union of the sperm and ovum from which the embryo develops.
fetus
Stage in prenatal development from 8 weeks to birth.
fimbriae
Finger- or fringe-like projections at the end of the fallopian tubes.
(singular:
fimbria)
follicleSecreted by the pituitary gland to stimulate maturation of the egg cell
stimulating
(ovum).
hormone
(FSH)
gamete
Male or female sexual reproductive cell; sperm cell or ovum.
genitalia
Reproductive organs; also called genitals.
gestation
Time period from fertilization of the ovum to birth; pregnancy.
gonad
Female or male reproductive organ that produces sex cells and hormones;
ovary or testis.
gynecology
Study of the female reproductive organs, including the breasts.
human
Hormone produced by the placenta to sustain pregnancy by stimulating (chorionic
tropin) the ovaries to produce estrogen and progesterone.
gonadotropin
(hCG)
hymen
Mucous membrane partially or completely covering the opening to the
vagina.
labia
Lips of the vagina; labia majora are the larger, outermost lips, and labia
minora are the smaller, innermost lips.
lactiferous
Tubes that carry milk from the mammary glands to the nipple.
ducts
luteinizing
Secreted by the pituitary gland to promote ovulation.
hormone
(LH)
mammary
Nipple of the breast. A papilla is any small nipple-shaped projection.
papilla
menarche
Beginning of the first menstrual period and ability to reproduce.
menopause
Gradual ending of menstruation.
481
menstruation Monthly shedding of the uterine lining. The flow of blood and tissue
normally discharged during menstruation is called the menses (Latin mensis
means month).
myometrium Muscle layer of the uterus.
neonatology Study of the medical care of the newborn (neonate).
obstetrics
Branch of medicine and surgery concerned with pregnancy and childbirth.
orifice
An opening.
ovarian
Developing sac enclosing each ovum within the ovary. Only about 400 of
follicle
these sacs mature in a woman's lifetime.
ovary
One of a pair of female organs (gonads) on each side of the pelvis. Ovaries
are almond-shaped, about the size of large walnuts, and produce egg cells
(ova) and hormones.
ovulation
Release of the ovum from the ovary.
ovum (plural: Mature egg cell (female gamete). Ova develop from immature egg cells
ova)
called oocytes.
parturition
Act of giving birth.
perimetrium Outermost layer of the uterus; uterine serosa.
perineum
In females, the area between the anus and the vagina.
pituitary
Endocrine gland at the base of the brain. It produces hormones that
gland
stimulate the ovaries. The pituitary gland also regulates other endocrine
organs.
placenta
Vascular organ a ached to the uterine wall during pregnancy. It permits the
exchange of oxygen, nutrients, and fetal waste products between mother
and fetus.
pregnancy
Gestation.
progesterone Hormone produced by the corpus luteum in the ovary and the placenta of
pregnant women.
puberty
Period of adolescent development at which secondary sex characteristics
appear and gametes are produced.
uterus
Hollow, pear-shaped muscular female organ in which the embryo and fetus
develop, and from which menstruation occurs. The upper portion is the
fundus; the middle portion is the corpus; and the lowermost, neck-like
portion is the cervix (see Figure 8-3, page 244).
vagina
Muscular, mucosa-lined canal extending from the uterus to the exterior of
the body.
vulva
External female genitalia; includes the labia, hymen, clitoris, and vaginal
orifice.
zygote
Stage in prenatal development from fertilization and implantation up to 2
weeks.
Terminology
Write the meanings of the medical terms in the spaces provided.
Combining Forms
482
COMBINING
MEANING
FORM
amni/o
amnion
bartholin/o
Bartholin
gland
cervic/o
chori/o,
chorion/o
colp/o
culd/o
cervix, neck
chorion
episi/o
vulva
galact/o
milk
gynec/o
woman,
female
hyster/o
uterus,
womb
lact/o
milk
mamm/o
breast
mast/o
breast
vagina
cul-de-sac
TERMINOLOGY
MEANING
amniocentesis __________________________________
amniotic fluid ___________________________________
Produced by fetal membranes and the fetus.
bartholinitis ___________________________________
A Bartholin cyst is a fluid-filled sac caused by blockage of a
duct from the Bartholin gland. If bacterial infection occurs, an
abscess may form.
endocervicitis ___________________________________
chorionic ___________________________________
colposcopy ___________________________________
culdocentesis ___________________________________
A needle is placed through the posterior wall of the vagina and
fluid is withdrawn for diagnostic purposes.
episiotomy ___________________________________
An incision through the skin of the perineum enlarges the
vaginal orifice for delivery. The incision is repaired by
perineorrhaphy.
galactorrhea ___________________________________
Abnormal, persistent discharge of milk, commonly seen with
pituitary gland tumors.
gynecomastia ___________________________________
Enlargement of breasts in a male. It often occurs with puberty
or aging, or the condition can be drug-related.
hysterectomy ___________________________________
Total abdominal hysterectomy (TAH) is removal of the
entire uterus (including the cervix) through an abdominal
incision (Figure 8-11). Vaginal hysterectomy (VH) is
removal through the vagina. Laparoscopic supracervical
hysterectomy (see Figure 8-11) is a partial hysterectomy that
preserves the cervix.
hysteroscopy ___________________________________
A gynecologist uses an endoscope (passed through the vagina
and cervix) to view the uterine cavity.
lactation ___________________________________
The normal secretion of milk.
inframammary ___________________________________
Infra- means below.
mammoplasty ___________________________________
Includes reduction and augmentation (enlargement)
operations.
mastitis ___________________________________
Usually caused by streptococcal or staphylococcal infection.
mastectomy ___________________________________
Mastectomy procedures are discussed under breast cancer (see
page 262).
483
COMBINING
MEANING TERMINOLOGY
MEANING
FORM
men/o
menses,
amenorrhea ___________________________________
menstruation
Absence of menses for 6 months or for more than three of the
patient's normal menstrual cycles.
dysmenorrhea ___________________________________
oligomenorrhea ___________________________________
Infrequent menstrual periods or scanty menses.
menorrhagia ___________________________________
Abnormally heavy or long menstrual periods. Fibroids (see
page 260) are a leading cause of menorrhagia.
metr/o,
uterus
metrorrhagia ___________________________________
metri/o
Bleeding between menses. Possible causes of metrorrhagia
include ectopic pregnancy, cervical polyps, and ovarian and
uterine tumors.
menometrorrhagia
___________________________________
Excessive uterine bleeding during and between menstrual
periods.
my/o, myom/o muscle,
myometrium ___________________________________
muscle
myomectomy ___________________________________
tumor
Removal of fibroids (myomas) from the uterus.
nat/i
birth
neonatal ___________________________________
obstetr/o
pregnancy
obstetrics ___________________________________
and
From the Latin obstetrix, midwife.
childbirth
o/o
egg
oogenesis ___________________________________
oocyte ___________________________________
Immature ovum.
oophor/o
ovary
oophorectomy ___________________________________
Oophor/o means to bear (phor/o) eggs (o/o). In a bilateral
oophorectomy, both ovaries are removed.
ov/o
egg
ovum ___________________________________
Mature egg cell.
ovari/o
ovary
ovarian ___________________________________
ovul/o
egg
anovulatory ___________________________________
perine/o
perineum
perineorrhaphy ___________________________________
phor/o
to bear
oophoritis ___________________________________
salping/o
fallopian
salpingectomy ___________________________________
tubes
Figure 8-12 shows a total hysterectomy with bilateral
salpingo-oophorectomy (BSO).
uter/o
uterus
uterine prolapse ___________________________________
vagin/o
vagina
vaginal orifice ___________________________________
An orifice is an opening.
vaginitis ___________________________________
Bacteria and yeasts (usually Candida) commonly cause this
infection. Use of antibiotic therapy may cause loss of normal
vaginal bacteria, resulting in an environment allowing yeast
to grow.
vulv/o
vulva
vulvovaginitis ___________________________________
vulvodynia ___________________________________
Chronic pain (with no identifiable cause) that affects the
vulvar area (labia, clitoris, and vaginal opening).
484
FIGURE 8-11 Normal uterus and hysterectomies. Total
hysterectomy is removal of the entire uterus—fundus, corpus,
and cervix. This may be performed via an abdominal incision or
vaginally. Laparoscopic supracervical hysterectomy is
removal of the top portion of the uterus (above the cervix),
leaving the cervix intact. Three to five small incisions are made in
the abdomen and the uterus is removed via laparoscope.
Robotic hysterectomy (da Vinci surgery) is another option
using small incisions, three-dimensional vision, and a magnified
view of the surgical site.
FIGURE 8-12 Total hysterectomy with bilateral salpingooophorectomy.
Suffixes
485
SUFFIX MEANING TERMINOLOGY
MEANING
-arche beginning menarche ____________________________________
-cyesis pregnancy
pseudocyesis _________________________________
Pseudo- means false. No pregnancy exists, but physical changes such
as weight gain and amenorrhea occur.
pregnant
primigravida ________________________________
gravida
A woman during her first pregnancy (primi- means first). Gravida also
is used to designate a pregnant woman, often followed by a number to
indicate the number of pregnancies (gravida 1, 2, 3).
-parous bearing,
primiparous __________________________________
bringing
An adjective describing a woman who has given birth to at least one
forth
child. Para also is used as a noun, often followed by a number to
indicate the number of deliveries after the 20th week of gestation (para
1, para 2, para 3). When a woman arrives in the birthing facility, her
gravidity and parity are important facts to include in the medical and
surgical history. For example, G2P2 is medical shorthand for a woman
who has had 2 pregnancies and 2 deliveries.
-rrhea discharge
leukorrhea ___________________________________
This vaginal discharge is normal or becomes more yellow (purulent or
pus-containing) as a sign of infection.
menorrhea ___________________________________
fallopian
pyosalpinx ___________________________________
salpinx (uterine)
tube
-tocia
labor, birth
dystocia ___________________________________
oxytocia ___________________________________
Oxy- means sharp or quick. The pituitary gland releases oxytocin,
which stimulates the pregnant uterus to contract (labor begins). It also
stimulates milk secretion from mammary glands.
act of
cephalic version ___________________________________
version turning
The fetus turns so that the head is the body part closest to the cervix
(version can occur spontaneously or can be performed by the
obstetrician). Fetal presentation is the manner in which the fetus
appears to the examiner during delivery. A breech presentation is
bu ocks first, or feet first in a footling breech; a cephalic presentation
is head first.
Prefixes
486
PREFIX MEANING TERMINOLOGY
MEANING
dyspainful
dyspareunia ____________________________________
(dis-pah-RU-ne-ah) Pareunia means sexual intercourse.
endowithin
endometritis ____________________________________
Usually caused by a bacterial infection.
inin
involution of the uterus ________________________________
Vol- means to roll. The uterus returns to its normal nonpregnant size.
intrawithin
intrauterine device ____________________________________
Figure 8-13A shows an IUD.
multi- many
multipara ____________________________________
multigravida ____________________________________
A woman who has been pregnant more than once.
nullino, not,
nulligravida ____________________________________
none
nullipara ____________________________________
Para 0. Figure 8-13B shows the cervix of a nulliparous woman and the
cervix of a parous woman (who has had a vaginal delivery).
prebefore
prenatal ____________________________________
primi- first
primipara ____________________________________
retrobackward
retroversion ____________________________________
The uterus is abnormally tilted backward. This occurs in 30% of
women.
FIGURE 8-13 A, Intrauterine device (IUD) in place to prevent
implantation of a fertilized egg. B, The cervix of a nulliparous
woman (the os, or opening, is small and perfectly round) and the
cervix of a parous woman (the os is wide and irregular). These
views would be visible under colposcopic examination.
487
Pathology: Gynecologic, Breast,
Pregnancy, and Neonatal
Gynecologic
Uterus
Cervical
cancer
(carcinoma
of the
cervix)
Malignant cells within the cervix.
Human papillomavirus (HPV) is the cause and risk factor for
developing cancer. Other factors that may act together with HPV to
increase the risk of developing cervical cancer include cigare e smoking,
having multiple sexual partners, and having a weakened immune system
(e.g., patients with AIDS). Human papillomavirus is the most widespread
sexually transmi ed infection in the world. In countries with high rates of
HPV infection, cervical cancer may become the most common cancer in
adult women. There are over 200 types of HPV. Some cause genital warts
(benign growths on the vulva, cervix, vagina, or anus), whereas others can
cause cancer, most commonly of the cervix, vagina, vulva, anus, penis, or
head and heck.
Most HPV infections are cleared by a person's immune system. A
persistent infection may lead to precancerous changes called cervical
intraepithelial neoplasia (CIN). See Figure 8-14 showing CIN progression.
CIN is also known as cervical dysplasia (abnormal cell growth).
Carcinoma in situ (CIS) is considered an early, localized, precancerous
form of cervical cancer and local resection (conization) of CIS may be
necessary to prevent development of invasive cancer. Figure 8-15 shows a
normal cervix and one with cervical cancer.
Surgical treatment for cervical cancer requires radical hysterectomy, in
which the entire uterus with ligaments, supportive tissues, and the top one
third of the vagina are removed. Radiation therapy and chemotherapy
with cisplatin are used to treat disease that has spread beyond the cervix,
into neighboring pelvic tissues, and to distant organs. Brachytherapy
(radioactive seeds implanted into the cervix) may also be an effective
treatment.
488
FIGURE 8-14 Precancerous neoplastic lesions are called
cervical intraepithelial neoplasia (CIN). Pathologists diagnose
such lesions from a Pap test (microscopic examination of cells
scraped from cervical epithelium) and grade them as CIN-1 to
CIN-3. Cervical carcinoma in situ (CIS) is equivalent to CIN-3.
These are precancerous lesions that have not yet invaded the
substance of the cervix.
FIGURE 8-15 Normal cervix (A) and cervix with cervical
cancer (B) as seen on colposcopy.
HPV Vaccine
HPV vaccines are given in a series of three shots over 6 months to
protect females and males against HPV infections. Girls can get this
vaccine to prevent cervical cancer, vulvar and vaginal cancer, and
489
genital warts. Boys get the vaccine to prevent anal cancer and genital
warts. The names of these vaccines are Cervarix, Gardasil, and Gardasil
9.
cervicitis
endometrial
cancer
(carcinoma of
the
endometrium)
endometriosis
fibroids
Inflammation of the cervix.
Bacteria such as Chlamydia trachomatis and Neisseria gonorrhoeae
commonly cause cervicitis. In acute cervicitis, the cervix is reddened
and can have an exudate (discharge) or even ulcerations.
After the presence of malignancy has been excluded (by Pap test or
biopsy), cryocauterization (destroying tissue by freezing) of the
diseased area and treatment with antibiotics may be indicated.
Malignant tumor of the uterine lining (adenocarcinoma).
The most common sign of endometrial cancer is postmenopausal
bleeding. This malignancy occurs more often in women exposed to
high levels of estrogen, either from estrogen replacement therapy,
estrogen-producing tumors, or obesity (estrogen is produced by fat
tissue). Physicians perform endometrial biopsy, hysteroscopy, and
dilation (widening the cervical canal) and cure age (scraping the inner
lining of the uterus) for diagnosis. When the cancer is confined to the
uterus, surgery (hysterectomy and bilateral salpingo-oophorectomy) is
curative. Radiation oncologists administer radiation therapy as
additional treatment.
Endometrial tissue located outside the uterus.
In endometriosis, endometrial tissue may be found in ovaries, fallopian
tubes, supporting ligaments, or small intestine, causing inflammation
and scar tissue. When the endometrium sheds and bleeds in its
monthly cycle, it may cause dysmenorrhea or pelvic pain. Infertility
(inability to become pregnant) and dyspareunia may also occur. Most
cases are the result of growth of bits of menstrual endometrium that
have passed backward through the lumen (opening) of the fallopian
tube and into the peritoneal cavity. When endometriosis affects the
ovaries, large cysts filled with menstrual blood (“chocolate cysts”)
develop. Symptoms may not correlate with the amount of the
endometriosis. Women may have extensive disease but no symptoms,
while others may have minimal endometriosis but severe symptoms.
Treatment ranges from symptomatic relief of pain and hormonal drugs
that suppress the menstrual cycle to surgical removal of ectopic
endometrial tissue and hysterectomy.
Benign tumors in the uterus.
Fibroids, also called leiomyomata or leiomyomas (lei/o = smooth, my/o
= muscle, and -oma = tumor), are composed of fibrous tissue and
muscle. If fibroids grow and cause symptoms such as metrorrhagia
(irregular periods), pelvic pain, or menorrhagia, (heavy periods), either
a myomectomy or hysterectomy is indicated. Fibroid ablation
(destruction) without surgery may be accomplished by uterine artery
embolization (UAE), in which tiny pellets (acting as emboli) are
injected into a uterine artery, blocking the blood supply to fibroids,
causing them to shrink. Figure 8-16A and B shows the location of
uterine fibroids.
490
FIGURE 8-16 A, Location of uterine fibroids (leiomyomas).
Pedunculated growths protrude on stalks. A subserosal mass
lies under the serosal (outermost) layer of the uterus. A
submucosal leiomyoma grows under the mucosal (innermost)
layer. Intramural (mural means wall) masses arise within the
muscular uterine wall. B, Fibroids shown after hysterectectomy.
Ovaries
491
ovarian
cancer
ovarian
cysts
Malignant tumor of the ovary (adenocarcinoma).
Each year, about 22,000 women in the United States are diagnosed with
ovarian cancer. Two types of ovarian cancer are most common: serous (clear
fluid) and mucinous (thick, pasty fluid) cystadenocarcinomas. The tumor
usually is discovered in an advanced stage as an abdominal mass and may
produce few symptoms in its early stages. When the disease metastasizes
beyond the ovary before diagnosis, ascites (accumulation of fluid in the
abdominal cavity) is often present. Treatment consists of surgery to remove as
much of the tumor as possible (tumor debulking). This may include
hysterectomy, bilateral salpingo-oophorectomy, and removal of the omentum
(fa y tissue that covers abdominal organs and often contains deposits of
tumor). Surgery is followed by systemic drug therapy, which is dependent on
the type of ovarian cancer. A protein marker produced by tumor cells, CA 125,
can be measured in the bloodstream to assess effectiveness of treatment.
Inherited mutations (changes) in genes greatly increase the risk of developing
ovarian and breast cancer. These mutations are BRCA1 and BRCA2 (short for
breast cancer 1 and breast cancer 2). Women with a strong family history of
ovarian cancer (with multiple members of the family affected) may seek
genetic counseling to determine if they should be tested for these inherited
defects. Prophylactic (preventive) oophorectomy significantly reduces the
odds of developing ovarian cancer if a woman is at high risk.
Fluid-filled sacs within the ovary.
Some cysts are benign and lined with typical ovarian cells. These cysts
originate in unruptured ovarian follicles (follicular cysts) or in follicles that
have ruptured and have immediately been sealed (luteal cysts). Other cysts are
malignant and lined with tumor cells (cystadenocarcinomas). Physicians
decide to remove these cysts to distinguish between benign and malignant
tumors.
Other benign ovarian cysts are dermoid cysts. They contain a variety of cell
types, including skin, hair, teeth, and cartilage, and arise from immature egg
cells in the ovary. Because of the strange assortment of tissue types in the
tumor (Figure 8-17), this tumor often is called a benign cystic teratoma
(terat/o = monster) or a mature teratoma. Surgical removal of the cyst cures
the condition.
FIGURE 8-17 Dermoid cyst of the ovary with hair, skin, and
teeth. (Courtesy Dr. Elizabeth Chabner Thompson.)
492
Fallopian Tubes
pelvic
inflammatory
disease (PID)
Inflammation and infection of organs in the pelvis and abdomen;
salpingitis, oophoritis, endometritis, endocervicitis.
PID is caused by sexually transmi ed infections. Repetitive episodes
of these infections lead to formation of adhesions and scarring within
the fallopian tubes. After PID, women have an increased risk of ectopic
pregnancy and infertility. Signs and symptoms include fever, vaginal
discharge, abdominal pain in the left and right lower quadrants (LLQ
and RLQ), and tenderness to palpation (examining by touch) of the
cervix. Antibiotics treat PID.
Sexually Transmitted Infections (STIs)
Examples of bacterial and viral STIs in women are:
• gonorrhea (gonococcal bacteria)
• chlamydia (chlamydial bacteria)
• syphilis (spirochete bacteria)
• genital herpes (herpes simplex virus—HSV)
• HPV infection and genital warts (human papillomavirus)
More information on STIs in women and men is on page 302.
Breast
493
breast
cancer
Malignant tumor of the breast (arising from milk glands and ducts).
The most common type of breast cancer is invasive ductal carcinoma
(IDC). Invasive means that the tumor has spread to surrounding breast
tissue. Figure 8-18A shows the tumor on a mammogram. Figure 8-18B
shows a cut section of an invasive ductal carcinoma. Other histopathologic
(histo- means tissue) types are lobular and medullary carcinoma of the
breast.
Ductal carcinoma in situ (DCIS) is non-invasive breast cancer. It starts in
milk ducts and does not spread beyond its original location (in situ). DCIS
can increase the risk of developing invasive breast cancer and is treated by
lumpectomy.
Breast cancer spreads first to lymph nodes in the axilla (armpit) nearest the
affected breast and then to the skin and chest wall. From the lymph nodes it
also may metastasize to other body organs, including bone, liver, lung, and
brain. The diagnosis is first established by biopsy, either core needle
aspiration or surgical removal of the specimen (solid mass or area of
microcalcification). A stereotactic core needle biopsy is performed with the
help of mammography for guidance.
For small primary tumors, the lump with immediately surrounding tissue
can be removed (lumpectomy). To determine whether the tumor has
spread to lymph nodes, a sentinel node biopsy (SNB) is performed. For
this procedure, a blue dye or a radioisotope is injected into the tumor site
and tracks to the axillary (underarm) lymph nodes. See Figure 8-19. After
lumpectomy, radiation therapy to the breast and to any involved lymph
nodes then follows, to kill remaining tumor cells.
An alternative surgical procedure is mastectomy (Figure 8-20A), which is
removal of the entire breast. After either lumpectomy or mastectomy if
lymph nodes are involved, or if the primary tumor was large, adjuvant
(aiding) chemotherapy is given to prevent recurrence of the tumor. Breast
reconstruction is an option after mastectomy. See Figure 8-20B. In patients
with large primary tumors, neoadjuvant chemotherapy (added prior to
surgery) may be administered to reduce tumor bulk and allow for complete
surgical removal of the tumor.
After surgery, further treatment may be indicated to prevent recurrence. To
determine which treatment is best, it is important to test the breast cancer
tumor for the presence of estrogen receptors (ERs). Two thirds of breast
cancers are ER-positive (ER+). These receptor proteins indicate that the
tumor will respond to therapy that blocks the estrogen stimulation of
estrogen. If metastases should subsequently develop, this information will
be valuable in selecting further treatment. There are two types of drugs that
block the effects of estrogen and thereby kill ER-positive breast cancer cells.
Drugs of the first type directly block the ER reception. An example is
tamoxifen. Drugs of the second type block the production of estrogen by
inhibiting the enzyme aromatase. These aromatase inhibitors are
particularly useful in treating postmenopausal women. Examples are
anastrozole (Arimidex) and letrozole (Femara).
A second receptor protein, HER2, is found in some breast cancers and
signals a high risk of tumor recurrence. Herceptin, an antibody that binds
to and blocks HER2, is effective in stopping growth when used with
chemotherapy. A new drug, pertuzumab, also targets HER2 and, combined
with Herceptin, is effective in treating HER2–positive advanced breast
cancer. Triple-negative tumors lack estrogen, progesterone, and HER2 and
are rapidly growing but respond well to chemotherapy.
Testing for hereditary mutations BRCA1, BRCA2, and PALB2 (partner and
localizer of BRCA1 and BRCA2) is advised for women with a strong family
history of breast cancer. Some women who test positively for the breast
494
fibrocystic
breast
disease
cancer genes elect to have prophylactic (preventive) bilateral mastectomy
with reconstruction to eliminate the risk of developing a new breast cancer.
See the In Person: Prophylactic Mastectomy story on page 275.
Numerous small sacs of fluid surrounded by dense strands of fibrous
tissue in the breast.
Women with this common benign condition notice a nodular (lumpy)
consistency of the breast, often associated with premenstrual tenderness
and fullness. Mammography and surgical biopsy are often indicated to
differentiate fibrocystic changes from breast cancer.
FIGURE 8-18 A, Arrows in mammogram point to invasive
breast cancer. A dense white fragment of calcium is seen at 2
o'clock in the mass; calcifications like this frequently are a sign of
cancer. B, Cut section of invasive ductal carcinoma of the
breast.
495
FIGURE 8-19 Sentinel node biopsy. After injection of dye or
radioisotope, its path is visualized and the sentinel (first) lymph
node is identified. It is the one most likely to contain a tumor if
cells have left the breast. The sentinel node is removed and
biopsied. If it is negative for tumor cells, the breast cancer has
not spread.
FIGURE 8-20 A, Surgical scar, mastectomy, right breast. A
modified radical mastectomy removes the breast and axillary
lymph nodes (usually 20 to 30 nodes). B, Reconstruction of
right breast after skin-sparing mastectomy. A gel silicone
implant was used. At a second operation, local tissue was
manipulated to create the semblance of a nipple-areola complex.
The procedure was completed by tattooing color around the
nipple. In this patient, the right breast tissue was removed
prophylactically and a silicone implant was inserted through an
inframammary incision. (A, Courtesy Dr. Elizabeth Chabner
Thompson.)
Pregnancy
496
abruptio
placentae
choriocarcinoma
ectopic
pregnancy
multiple
gestations
placenta previa
preeclampsia
Premature separation of the normally implanted placenta.
Abruptio placentae (Latin ab, away from; ruptus, ruptured) occurs
because of trauma, such as a fall, or may be secondary to vascular
insufficiency resulting from hypertension or preeclampsia (see page
265). Signs and symptoms of acute abruption include sudden searing
(burning) abdominal pain and bleeding. It is an obstetric emergency.
Malignant tumor of the placenta.
This extremely rare cancerous tumor comes from cells that were part
of the placenta in a normal pregnancy. Treatment of metastatic
choriocarcinoma may include chemotherapy and radiation therapy
to distant sites of cancer.
Implantation of the fertilized egg outside the uterus.
The condition occurs in 1-2% of all pregnancies, and most of these
occur in the fallopian tubes (tubal pregnancy). Rupture of the ectopic
implant within the fallopian tube can lead to massive abdominal
bleeding and death. Surgeons can remove the implant, or treatment
with medication (methotrexate) can destroy it, thereby preserving
the fallopian tube before rupture occurs. Other sites of ectopic
pregnancy include the ovaries and abdominal cavity; whatever the
location, ectopic pregnancy often constitutes a surgical emergency.
Presence of more than one embryo developing in the uterus during
pregnancy.
Multiple births are increasing in the United States. This is because of
assisted reproductive technology (ART) such as ovulation induction
followed by intrauterine insemination (IUI) or in vitro fertilization
(IVF). These pregnancies are at higher risk for preterm delivery, fetal
growth restriction, high blood pressure, and diabetes.
Implantation of the placenta over the cervical opening or in the
lower region of the uterus (Figure 8-21).
Maternal signs and symptoms include painless bleeding,
hemorrhage, and premature labor. Cesarean delivery usually is
recommended.
Abnormal condition associated with pregnancy, marked by high
blood pressure, proteinuria, edema, and headache.
Mild preeclampsia can be managed by bed rest and close monitoring
of blood pressure. Women with severe preeclampsia need treatment
with medications such as magnesium sulfate to prevent seizures, and
the baby is delivered as quickly as possible. The Greek word
eklampein means to shine forth, referring to the convulsions and
hypertension—typically with visual symptoms of flashing lights—
that accompany the condition. Eclampsia is the final and most severe
phase of untreated preeclampsia. It often causes seizures and even
death of the mother and baby.
497
Placenta previa. Previa means before or in the front of.
Three forms of this abnormal implantation of the placenta are:
placenta accreta (on the wall but not in muscle), placenta increta (in
uterine muscle), and placenta percreta (attaching to another organ).
FIGURE 8-21
Neonatal
The following terms describe conditions or symptoms that can affect the
newborn. The Apgar score (Figure 8-22) is a system of scoring an
infant's physical condition at 1 minute and again at 5 minutes after
birth. Heart rate, respiration, color, muscle tone, and response to
stimuli each are rated 0, 1, or 2. The maximum total score is 10. Infants
with Apgar scores below 7 require immediate medical a ention such as
suctioning of the airways or oxygen to help breathing.
Apgar scoring chart. This test is named for
anesthesiologist Virginia Apgar (1909-1974), who devised it in 1953.
Dr. Joseph Butterfield, in 1963, introduced an “APGAR” acronym
as a mnemonic (memory device): Appearance (color), Pulse (heart
rate), Grimace (response to catheter in nostril), Activity (muscle
tone), and Respiration (respiratory effort).
FIGURE 8-22
498
Down
syndrome
Hemolytic
disease in the
newborn
(HDN)
infant
respiratory
distress
syndrome
(IRDS)
hydrocephalus
meconium
aspiration
syndrome
pyloric
stenosis
Chromosomal abnormality (trisomy 21) results in mental retardation,
retarded growth, and a flat face with a short nose, low-set ears, and
slanted eyes.
Destruction of red blood cells in the newborn caused by a blood
group (Rh factor) incompatibility between the mother and the fetus.
See explanation in Chapter 4, page 115.
Acute lung disease commonly seen in the premature newborn.
This condition is caused by deficiency of surfactant, a protein
necessary for proper lung function. Surfactant can be administered to
the newborn to cure the condition. This condition was previously
called hyaline membrane disease.
Accumulation of fluid in the spaces of the brain.
In an infant with this condition, the entire head can enlarge because
the bones of the skull do not completely fuse together at birth. Infants
normally have a soft spot or fontanelle between the cranial bones that
allows for some swelling during the birth of the baby. Hydrocephalus
occurs because of a problem in the circulation of fluid within the brain
and spinal cord, resulting in fluid accumulation.
Abnormal inhalation of meconium produced by a fetus or newborn.
Meconium, a thick, sticky, greenish to black substance, is the first
intestinal discharge (stools) from newborns. Intrauterine distress can
cause its passage into amniotic fluid. Once the meconium has passed
into the surrounding amniotic fluid, the fetus may breath meconium
into its lungs. It can cause breathing problems due to inflammation in
the baby's lungs after birth.
Narrowing of the opening of the stomach to the duodenum.
This condition may be present at birth and frequently is associated
with Down syndrome. Surgical repair of the pyloric opening may be
necessary.
499
Clinical Tests and Procedures
Clinical Tests
Pap test
(Pap
smear)
Microscopic examination of stained cells removed from the vagina and
cervix.
After inserting a vaginal speculum (instrument to hold apart the vaginal
walls), the physician uses a small spatula to remove exfoliated (peeling and
sloughing off) cells from the cervix and vagina (Figure 8-23). Microscopic
analysis of the cell smear detects cervical or vaginal cellular abnormalities.
pregnancy Blood or urine test to detect the presence of hCG.
test
FIGURE 8-23 Method of obtaining a sample for a Pap test. The
test is 95% accurate in diagnosing early cervical cancer. It was
invented by and named for a Greek physician, Georgios
Papanicolaou.
Procedures
X-Ray Studies
500
hysterosalpingography
(HSG)
mammography
X-ray imaging of the uterus and fallopian tubes after
injection of contrast material.
This radiologic procedure is used to evaluate tubal patency
(adequate opening) and uterine cavity abnormalities.
X-ray imaging of the breast.
Women are advised to have a baseline mammogram at 40-44
years of age for later comparison if needed.
The most recent method of mammography is digital
tomosynthesis. See Figure 8-24. In this procedure, an x-ray
tube moves in an arc around the breast as several images are
taken. These images are sent to a computer and clear, highly
focused three-dimensional pictures are produced. This
procedure makes breast cancer easier to find in dense breast
tissue; also called 3D mammography.
501
FIGURE 8-24 A, Mammography. The machine compresses the
breast and x-ray pictures (top to bottom and lateral) are taken. B,
Comparison of mammogram and digital tomosynthesis
images.
Ultrasound Examination and Magnetic Resonance
Imaging (MRI)
502
breast
ultrasound
imaging and
breast MRI
pelvic
ultrasonography
Technologies using sound waves and a magnetic field to create
images of breast tissue.
These imaging techniques confirm the presence of a mass and can
distinguish a cystic from a solid mass. MRI is very useful in detecting
masses in young women with dense breasts or in women with a
strong family history of breast cancer and at high risk for this
condition. Breast ultrasound imaging is useful to evaluate a specific
area of cancer on a mammogram.
Recording images of sound waves as they bounce off organs in the
pelvic region.
This technique can evaluate fetal size and anatomy, as well as fetal
and placental position. Uterine tumors and other pelvic masses,
including abscesses, also are diagnosed by ultrasonography.
Transvaginal ultrasound allows the radiologist a closer, sharper look
at organs within the pelvis. The sound probe is placed in the vagina
instead of over the pelvis or abdomen; this method is best used to
evaluate fluid-filled cysts.
Gynecologic Procedures
503
cauterization
colposcopy
conization
cryosurgery
culdocentesis
dilation
(dilatation)
and cure age
(D&C)
exenteration
fine needle
aspiration
laparoscopy
tubal ligation
Destruction of tissue by burning.
Destruction of abnormal tissue with chemicals (silver nitrate) or an
electrically heated instrument. Cauterization is used to treat cervical
dysplasia or cervical erosion. The loop electrocautery excision
procedure (LEEP) (see Figure 8-26A) is used to further assess and often
treat abnormal cervical tissue.
Visual examination of the vagina and cervix using a colposcope.
A colposcope is a lighted magnifying instrument resembling a small,
mounted pair of binoculars. Gynecologists prefer colposcopy for pelvic
examination when cervical dysplasia is present because it identifies the
specific areas of abnormal cells. A biopsy specimen can then be taken for
more accurate diagnosis (Figure 8-25).
Removal of a cone-shaped section (cone biopsy) of the cervix.
The physician resects the tissue using a LEEP (loop electrocautery
excision procedure), or with a carbon dioxide laser or surgical knife
(scalpel). Figure 8-26A shows conization with LEEP, and Figure 8-26B
shows the cone biopsy specimen removed surgically.
Use of cold temperatures to destroy tissue.
A liquid nitrogen probe produces the freezing (cry/o means cold)
temperature. Also called cryocauterization.
Needle aspiration of fluid from the cul-de-sac.
The physician inserts a needle through the vagina into the cul-de-sac.
The presence of blood may indicate a ruptured ectopic pregnancy or
ruptured ovarian cyst.
Widening the cervix and scraping off the endometrial lining of the
uterus.
Dilation is accomplished by inserting a series of dilators of increasing
diameter. A curet (metal loop at the end of a long, thin handle) is then
used to sample the uterine lining. This procedure helps diagnose uterine
disease and can temporarily halt prolonged or heavy uterine bleeding.
When necessary, a D&C is used to remove the tissue during a
spontaneous or therapeutic abortion (Figure 8-27).
Removal of internal organs within a cavity.
Pelvic exenteration is removal of the organs and adjacent structures of
the pelvis.
Withdrawal of fluid or tissue from a cyst or solid mass by suction with
a needle.
FNA is a valuable diagnostic technique in evaluating lumps of the
breast.
Visual examination of the abdominal cavity using an endoscope
(laparoscope).
In this procedure, a form of minimally invasive surgery (MIS), small
incisions (5 to 10 mm long) are made near the woman's navel for
introduction of the laparoscope and other instruments. Uses of
laparoscopy include inspection and removal of ovaries and fallopian
tubes, diagnosis and treatment of endometriosis, and removal of
fibroids. Laparoscopy also is used to perform subtotal (cervix is left in
place) and total hysterectomies (Figure 8-28).
Morcellation (cu ing up uterine tissue in the abdomen) is commonly
performed when the uterus or fibroids are removed laparoscopically. It
is contraindicated in situations of suspcious or pre-malignancy.
Blocking the fallopian tubes to prevent fertilization from occurring.
This sterilization procedure (making an individual incapable of
reproduction) is performed using laparoscopy or through a
hysteroscope inserted via the cervical os (opening). Ligation means
504
tying off and does not pertain solely to the fallopian tubes—which may
be “tied” using clips or bands, or by surgically cu ing or burning
through the tissue.
FIGURE 8-25 Colposcopy is used to evaluate a patient with an
abnormal Pap test result. For this examination, the woman lies in
the dorsal lithotomy position. This is the same position used to
remove a urinary tract stone (lithotomy means incision to remove
a stone).
FIGURE 8-26 A, Cervical loop electrocautery excision
procedure (LEEP) for cone biopsy. B, Surgical removal of cone
biopsy specimen. (A, Courtesy Dr. A. K. Goodman, Massachusetts
General Hospital, Boston.)
505
FIGURE 8-27 Dilation and curettage (D&C) of the uterus. A,
The uterine cavity is explored with a uterine sound (a slender
instrument used to measure the depth of the uterus) to prevent
perforation during dilation. B, Uterine dilators (Hanks or Hagar)
in graduated sizes are used to gradually dilate the cervix. C, The
uterus is gently curetted and specimens are collected.
FIGURE 8-28 Laparoscopic oophorectomy. A, Notice the
ovary placed in a plastic bag. The bag was inserted through the
laparoscope and then opened, and the ovary was placed inside.
B, Both are extracted through the laparoscope, leaving the uterus
and the cut end of the fallopian tube. (Courtesy Dr. A. K. Goodman,
Massachusetts General Hospital, Boston.)
Procedures Related to Pregnancy
506
abortion (AB)
Termination of pregnancy before the embryo or fetus can exist on its
own.
Abortions are spontaneous or induced. Spontaneous abortions,
commonly called “miscarriages,” occur without apparent cause.
Induced abortions can be therapeutic or elective. A therapeutic
abortion is performed when the health of the pregnant woman is
endangered. An elective abortion is performed at the request of the
woman. Major methods for abortion include vaginal evacuation by
D&C or vacuum aspiration (suction) and stimulation of uterine
contractions by injection of saline (salt solution) into the amniotic cavity
(in second-trimester pregnancies).
amniocentesis
Needle puncture of the amniotic sac to withdraw amniotic fluid for
analysis (Figure 8-29).
The cells of the fetus, found in the fluid, are cultured (grown), and
cytologic and biochemical studies are performed to check fetal
chromosomes, concentrations of proteins and bilirubin, and fetal
maturation.
cesarean
Surgical incision of the abdominal wall and uterus to deliver a fetus.
section
Indications for cesarean section include cephalopelvic disproportion
(the baby's head is too big for the mother's birth canal), abruptio
placentae or placenta previa, fetal distress (fetal hypoxia), and breech
or shoulder presentation. The name comes from a law during the time
of Julius Caesar requiring removal of the fetus before a deceased
pregnant woman could be buried.
chorionic
Sampling of placental tissues (chorionic villi) for prenatal diagnosis.
villus
The sample of tissue is removed with a catheter inserted into the
sampling
uterus. The procedure can be performed earlier than amniocentesis, at
(CVS)
10 or more weeks of gestation.
fetal
Continuous recording of the fetal heart rate and maternal uterine
monitoring
contractions to assess fetal status and the progress of labor.
in vitro
Egg and sperm cells are combined outside the body in a laboratory
fertilization
dish (in vitro) to facilitate fertilization.
(IVF)
After an incubation period of 3 to 5 days, the fertilized ova are injected
into the uterus through the cervix. (Latin in vitro means in glass, as
used for laboratory containers.) From 30% to 50% of all IVF procedures
are now associated with intracytoplasmic sperm injection (ICSI). This
is the direct injection of sperm into harvested ova.
507
FIGURE 8-29 Amniocentesis. The obstetrician places a long
needle through the pregnant woman's abdominal wall into the
amniotic cavity. Needle placement (avoiding the fetus and the
placenta) is guided by concurrent ultrasound imaging, performed
using the transducer in the radiologist's hand. The yellow
amniotic fluid is aspirated into the syringe attached to the needle.
This procedure took place in the 16th week of pregnancy. The
indication for the amniocentesis was a low alpha-fetoprotein
(AFP) level. This finding suggested a higher risk of Down
syndrome in the baby. Karyotype analysis (received 10 days
later) showed normal chromosome configuration.
Abbreviations
508
AB
AFP
abortion
alpha-fetoprotein—high levels in amniotic fluid of fetus or maternal serum
indicate increased risk of neurologic birth defects in the infant.
ART
Assisted Reproductive Techniques including IVF and sperm donation
BRCA1
breast cancer 1 and 2—genetic mutations associated with increased risk for
BRCA2
breast cancer
BSE
breast self-examination
CA-125
protein marker elevated in ovarian cancer
C-section, cesarean section
CS
CIN
cervical intraepithelial neoplasia
CIS
carcinoma in situ
CVS
chorionic villus sampling
Cx
cervix
D&C
dilation (dilatation) and cure age
DCIS
ductal carcinoma in situ; a precancerous breast lesion that indicates a higher
risk for invasive ductal breast cancer
DUB
dysfunctional uterine bleeding
FHR
fetal heart rate
FNA
fine needle aspiration
FSH
follicle-stimulating hormone
G
gravida (pregnant)
GnRH
gonadotropin-releasing hormone—secreted by the hypothalamus to stimulate
release of FSH and LH from the pituitary gland
GYN
gynecology
hCG or
human chorionic gonadotropin
HCG
HDN
hemolytic disease of the newborn
HPV
human papillomavirus
HRT
hormone replacement therapy
HSG
hysterosalpingography
IUD
intrauterine device; contraceptive
IDC
invasive ductal carcinoma
IRDS
infant respiratory distress syndrome
IVF
in vitro fertilization
LEEP
loop electrocautery excision procedure
LH
luteinizing hormone
LMP
last menstrual period
multip
multipara; multiparous
OB
obstetrics
para 2-0-1- a woman's reproductive history: 2 full-term infants, 0 preterm, 1 abortion, and
2
2 living children
Pap test
test for cervical or vaginal cancer
PID
pelvic inflammatory disease
PMS
premenstrual syndrome
primip
primipara; primiparous
SLN
sentinel lymph node biopsy—blue dye or a radioisotope (or both) identifies the
biopsy or first lymph node draining the breast lymphatics
SNB
TAH-BSO total abdominal hysterectomy with bilateral salpingo-oophorectomy
UAE
uterine artery embolization
VH
vaginal hysterectomy
509
Practical Applications
This section contains an actual operative report and brief excerpts from
other medical records using words that you have studied in this and
previous chapters. Explanations of more difficult terms are added in
brackets.
Operative Report
Preoperative diagnosis: Menorrhagia, leiomyomata
Anesthetic: General
Material forwarded to laboratory for examination:
A. Endocervical cure ings
B. Endometrial cure ings
Operation performed: Dilation and cure age of the uterus
With the patient in the dorsal lithotomy position [legs are flexed on
the thighs, thighs flexed on the abdomen and abducted] and sterilely
prepped and draped, manual examination of the uterus revealed it to
be 6- to 8-week size, retroflexed; no adnexal masses noted. The anterior
lip of the cervix was then grasped with a tenaculum [a hook-like
surgical instrument for grasping and holding parts]. The cervix was
dilated up to a #20 Hank's dilator. The uterus was sounded [depth
measured] up to 4 inches. A sharp cure age of the endocervix showed
only a scant amount of tissue. With a sharp curet, the uterus was
cure ed in a clockwise fashion with an irregularity noted in the
posterior floor. A large amount of endometrial tissue was removed. The
patient tolerated the procedure well.
Operative diagnosis: Leiomyomata uteri
Recommendation: Hysterectomy for myomectomy
Sentences Using Medical Terminology
1. Mammogram report: The breast parenchyma [essential tissue] is
symmetric bilaterally. There are no abnormal masses or
calcifications in either breast. The axillae are normal.
2. This is a 43-year-old gravida 3, para 2 with premature ovarian
failure and now on HRT. She has history of endocervical atypia
[cells are not normal or typical] secondary to chlamydial
infection, which is now being treated.
510
3. The patient is a 40-year-old gravida 3, para 2 admi ed for
exploratory laparotomy to remove and evaluate a 10-cm left
adnexal mass. Discharge diagnosis: (1) endometriosis, left ovary;
(2) benign cystic teratoma [dermoid cyst], left ovary.
4. History: 51-year-old G3 P3; LMP early 40s; on HRT until age 49
when diagnosed with carcinoma of breast; treated with
mastectomy and tamoxifen. Followed by ultrasounds showing
slightly thickened 9-10 mm endometrium. No bleeding.
Operative findings: office endometrial biopsy, scant tissue
Clinical diagnosis: rule out hyperplasia
Operating Room Schedule
The operating room schedule for one day in a large general hospital
listed six different gynecologic procedures. Match the surgical
procedures in Column I with the indications for surgery in Column II.
Write the le er of the indication in the blanks provided. Answers are
on page 286.
COLUMN I
1. Left oophorectomy
2. Vaginal hysterectomy with colporrhaphy
3. TAH-BSO, pelvic and periaortic
lymphadenectomy
4. Exploratory laparotomy for uterine
myomectomy
5. Conization of the cervix
6. Lumpectomy with SLN biopsy
COLUMN II
_______ A. LLQ pain; ovarian mass on pelvic
_______ ultrasound
_______ B. Fibroids
C. Endometrial cancer
_______ D. Small invasive ductal carcinoma of
the breast
E.
Suspected cervical cancer
_______
F.
Uterine
prolapse
_______
Contraceptive Choices
Review and compare the various birth control options available today.
511
METHOD
1. Abstinence—no sexual intercourse
2. Cervical cap—inserted by doctor or nurse
3. Condom—male
4. Condom—female
5. Diaphragm (with spermicide)
6. Film and foam (with spermicide)
7. Implant—inserted into upper arm; releases
hormones; effective for 3 years
8. Injectable—Depo-Provera given every 3
months
9. Intrauterine device (IUD)
10. Oral contraceptives (birth control pills)
11. Patch—applied to skin weekly
12. Ring—inserted in vagina; effective for 1
month
13. Sponge—used by women who have never
given birth
14. Suppositories—inserted in vagina (with
spermicide)
15. Withdrawal
UNINTENDED PREGNANCY RATES:
TYPICAL USE/PERFECT USE
0% / 0%
16% / 9%
15% / 2%
21% / 5%
16% / 6%
29% / 18%
0.05% / 0.05%
3% / 3%
less than 1%
8% / 3%
8% / 3%
8% / less than 1%
16% / 9%
29% / 15%
27% / 4%
In Person
Prophylactic Mastectomy
Whenever May rolls around, I think about my surgery and the decision
I made many years ago to have prophylactic mastectomies. I grew up in
a family of strong women. They were determined to work, play sports,
512
and raise their families, except they all had breast cancer. It was a bump
in the road for each one of them and, at age 36, I had 4 children, a
wonderful career and a husband and abnormal mammograms. I had
friends, holidays, and biopsies, and being a physician (radiation
oncologist) and the daughter of a medical oncologist, I was worried
about my own health.
When my mother tested negative for the BRCA gene, it did not
relieve my anxiety. It just intensified it. What was causing the breast
cancer in my family? Genetic counselors explained that only about 15%
of breast cancer can be a ributed to the BRCA genes; the rest are
caused by other “faulty genes” or just changes in the breast cells.
I heard about a new procedure that physicians were pioneering—
direct-to-implant breast reconstruction after mastectomy. One step and
one surgery would drop my risk from 40% to close to 2% or 3%. I could
preserve my anatomy and get rid of those breast cells that might kill me
someday. It had a lot to do with my family and career. I did not want to
have breast cancer.
So I decided, after much research and discussion, to have
prophylactic mastectomies with reconstruction. On a Tuesday in the
first week of May 2006, I had my surgery. My mother was there when I
woke up from anesthesia, and I have never seen her so relieved. My
husband took care of the kids, closed the car doors for me, and took
over mowing the lawn for a while. I didn't discuss my surgery,
especially not with the freedom that Angelina Jolie did in 2013. In 2006,
no one had heard of my surgery; they couldn't even pronounce the
name of it. But I was convinced that it meant I might very well “dodge
a bullet.”
Nine years later, I smile when I see morning television shows talk
about the “Angelina Effect”—implants and breast reconstruction,
nipples, and risk reduction, all in the same story. It's wonderful that
women can talk about their “faulty parts” without feeling shame. It's a
great example for our daughters as well.
In March of 2015, Angelina wrote another op-ed, discussing her
oophorectomy and salpingectomy surgery (removal of both ovaries and
both fallopian tubes). Women with BRCA genes have an increased risk
not only for breast cancer but also for ovarian cancer. And this was the
disease that took Angelina's mother's life. Ovarian cancer, unlike breast
cancer, is often diagnosed at a very late stage. A majority of breast
cancers are diagnosed at stage 1 or 2 or even at a “pre-cancer” DCIS
[ductal carcinoma in situ] stage. Ovarian cancer, on the other hand,
often is diagnosed after the cancer has already spread. Angelina also
discussed another “taboo” subject: Removing ovaries and the fallopian
tubes in a premenopausal woman (Angelina was 39 years old at the
513
time of her surgery) sends her into early menopause. Hot flashes, skin
changes, dryness (you know where) are hard topics to discuss in
public. She put it out there, front and center, to destigmatize the subject
for all women.
There is no history of ovarian cancer in my family, and we are BRCAnegative, so my genetic counselor did not recommend removing my
ovaries and fallopian tubes. Rather, I have a pelvic ultrasound once a
year and a blood test (CA-125) to make sure that nothing is abnormal.
Because of my decision to undergo prophylactic mastectomies, I
know that my life has changed for the be er. I don't have the fear of
ge ing breast cancer. I also have decided to devote my life work to
helping women recover with comfort, dignity, and grace after being
blindsided by the disease. Angelina Jolie says that knowledge is power!
It behooves us to learn as much as we can to prevent disease and
proactively take care of the fragile, precious thing we call our health.
Elizabeth Chabner Thompson is the CEO/Founder of Masthead, a company
devoted to bringing innovative products to patients with breast cancer. She is a
physician, swimmer, cross country skier and the proud mother of four children
ages 16-21.
514
Exercises
Remember to check your answers carefully with the Answers to
Exercises, page 284.
A Match the following terms for structures or tissues
with their meanings below.
amnion
areola
cervix
chorion
clitoris
endometrium
fallopian tubes
fimbriae
labia
mammary papilla
ovaries
perineum
placenta
perimetrium
vagina
vulva
1. inner lining of the uterus
_____________________________________
2. area between the anus and the vagina in females
_____________________________________
3. dark-pigmented area around the breast nipple
_____________________________________
515
4. finger-like ends of the fallopian tube
_____________________________________
5. ducts through which the egg travels into the uterus
from the ovary
_____________________________________
6. organ of sensitive erectile tissue in females; anterior
to urethral orifice
__________________________________
7. nipple of the breast
_____________________________________
8. vascular organ that a aches to the uterine wall
during pregnancy _________________________
9. lower, neck-like portion of the uterus
_____________________________________
10. innermost membrane around the developing
embryo ___________________________________
11. outermost layer of the membranes around the
developing embryo and forming part of the
placenta _____________________________________
12. outermost layer surrounding the uterus
_____________________________________
13. lips of the vulva
_____________________________________
14. female gonads; producing ova and hormones
_____________________________________
15. includes the perineum, labia and clitoris, and
hymen; external genitalia _____________________
16. muscular, mucosa-lined canal extending from the
uterus to the exterior of the
body___________________________________
516
B Identify the following terms.
1. fetus
___________________________________________
2. lactiferous ducts
_____________________________________
3. gametes _____________________________________
4. gonads _____________________________________
5. adnexa uteri
_____________________________________
6. cul-de-sac
_____________________________________
7. genitalia _____________________________________
8. Bartholin glands
_____________________________________
9. ovarian follicle
_____________________________________
10. corpus luteum
_____________________________________
C Match the listed terms with the
descriptions/definitions that follow.
coitus
estrogen
fertilization
follicle-stimulating hormone
human chorionic gonadotropin
luteinizing hormone
menarche
myometrium
prenatal
517
progesterone
1. hormone produced by the ovaries; promotes
female secondary sex
characteristics__________________
2. hormone secreted by the pituitary gland to
stimulate maturation of the egg cell
(ovum)_____________________________________
3. sexual intercourse
_____________________________________
4. before birth
_____________________________________
5. beginning of the first menstrual period
_____________________________________
6. hormone produced by the placenta to sustain
pregnancy by stimulating the ovaries to produce
estrogen and progesterone
_____________________________________
7. muscle layer of the uterus
_____________________________________
8. hormone produced by the corpus luteum in the
ovary and the placenta of a pregnant
woman_____________________________________
9. hormone produced by the pituitary gland to
promote ovulation ___________________________
10. union of the sperm cell and ovum from which the
embryo develops _______________________
D Supply definitions to complete the following
sentences.
1. galact/o and lact/o both mean
______________________________.
518
2. colp/o and vagin/o both mean
______________________________.
3. mamm/o and mast/o both mean
_____________________________.
4. metr/o, uter/o, and hyster/o all mean
_________________________.
5. oophor/o and ovari/o both mean
____________________________.
6. o/o, ov/o, and ovul/o all mean
______________________________.
7. in- and endo- both mean
__________________________________.
8. -cyesis and -gravida both mean
_____________________________.
9. salping/o and -salpinx both mean
___________________________.
10. episi/o and vulv/o both mean
_____________________________.
E Match the listed terms with the
meanings/descriptions that follow.
bilateral salpingo-oophorectomy
cervicitis
chorion
culdocentesis
lactation
neonatology
obstetrics
oxytocin
total hysterectomy
519
vulvovaginitis
1. study of the newborn
______________________________
2. hormone that stimulates the pregnant uterus to
contract ______________________________
3. secretion of milk ______________________________
4. removal of the entire uterus
______________________________
5. inflammation of the neck of the uterus
______________________________
6. branch of medicine concerned with pregnancy and
childbirth ___________________________
7. outermost membrane surrounding the fetus
______________________________
8. removal of both fallopian tubes and both ovaries
______________________________
9. inflammation of the external female genitalia and
vagina ______________________________
10. needle puncture to remove fluid from the cul-desac ______________________________
F Give the meanings of the following signs and
symptoms.
1. amenorrhea
_____________________________________________
______________________
2. dysmenorrhea
_____________________________________________
______________________
3. leukorrhea
_____________________________________________
520
________________________
4. metrorrhagia
_____________________________________________
_______________________
5. galactorrhea
_____________________________________________
________________________
6. menorrhagia
_____________________________________________
________________________
7. pyosalpinx
_____________________________________________
________________________
8. dyspareunia
_____________________________________________
____________________
9. menometrorrhagia
_____________________________________________
______________
10. oligomenorrhea
_____________________________________________
______________
G State whether the following sentences are true or
false, and explain your answers.
1. After a total (complete) hysterectomy, a woman
still has regular menstrual periods.
_______________________________________________
________________
2. After a total hysterectomy, a woman may still
produce estrogen and progesterone.
521
___________________________________________
3. Birth control pills prevent pregnancy by keeping
levels of estrogen and progesterone high.
_______________________________________________
_______________________
4. After a total hysterectomy with bilateral salpingooophorectomy, a doctor may advise hormone
replacement therapy.
_______________________________________________
______
5. Human papillomavirus can cause genital warts and
ovarian cancer.
_______________________________________________
_________________
6. A Pap test can detect cervical dysplasia.
_______________________________________
7. Human chorionic gonadotropin is produced by the
ovaries during pregnancy.
_______________________________________________
________________________
8. Gynecomastia is a common condition in pregnant
women.
_______________________________________________
________________________
9. Treatment for endometriosis is uterine
myomectomy.
_______________________________________________
________________________
10. A gravida 3 para 2 is a woman who has given
birth 3 times.
522
_______________________________________________
_____________________
11. A nulligravida is a woman who has had several
pregnancies.
_______________________________________________
___________________________
12. Pseudocyesis is the same condition as a tubal
pregnancy.
_______________________________________________
_________________________
13. Fibrocystic changes in the breast are a malignant
condition.
_______________________________________________
________________________
14. Cystadenomas occur in the ovaries.
_______________________________________________
_____________________
15. FSH and LH are ovarian hormones.
_______________________________________________
____________________
H Give the meanings of the following terms.
1. parturition
_____________________________________________
__
2. menopause
_____________________________________________
__
3. menarche
_____________________________________________
__
523
4. ovulation
_____________________________________________
__
5. gestation
_____________________________________________
__
6. anovulatory
_____________________________________________
__
7. dilatation
_____________________________________________
__
8. lactation
_____________________________________________
__
9. nulliparous
_____________________________________________
__
10. oophoritis
_____________________________________________
__
11. bartholinitis
_____________________________________________
__
12. vulvodynia
_____________________________________________
__
I Match the listed terms with the
meanings/descriptions that follow.
abruptio placentae
cervical cancer
524
cervicitis
cystadenocarcinoma
endometrial cancer
endometriosis
leiomyoma
multiple gestations
placenta previa
preeclampsia
1. malignant tumor of the ovary
___________________________
2. inflammation in the lower, neck-like portion of the
uterus ___________________________
3. condition during pregnancy or shortly thereafter,
marked by hypertension, proteinuria, and edema
___________________________
4. uterine tissue located outside the uterus—for
example, in the ovaries, cul-de-sac, fallopian tubes,
or peritoneum ___________________________
5. premature separation of a normally implanted
placenta ___________________________
6. placenta implantation over the cervical opening
___________________________
7. more than one fetus inside the uterus
___________________________
8. malignant condition of the lower portion of the
uterus ___________________________
9. malignant condition of the inner lining of the
uterus ___________________________
10. benign muscle tumor in the uterus
___________________________
525
J Name the appropriate test or procedure for each of
the following descriptions.
1. Burning of abnormal tissue with chemicals or an
electrically heated instrument:
____________________________________
2. Contrast material is injected into the uterus and
fallopian tubes, and x-ray images are
obtained:____________________________________
3. Cold temperature is used to destroy tissue:
_______________________________
4. Visual examination of the vagina and cervix:
____________________________________
5. Widening the cervical opening and scraping the
lining of the
uterus:____________________________________
6. Withdrawal of fluid or tissue from a cyst or solid
mass by suction with a
needle:____________________________________
7. Process of recording x-ray images of the breast:
____________________________________
8. Removal of a cone-shaped section of the cervix for
diagnosis or treatment of cervical dysplasia:
____________________________________
9. Surgical puncture to remove fluid from the cul-desac: ___________________________
10. Echoes from sound waves create an image of
structures in the pelvic
region:____________________________________
11. Blocking the fallopian tubes to prevent
fertilization from occurring:
____________________________________
526
12. Visual examination of the abdominal cavity with
an
endoscope:___________________________________
_
13. hCG is measured in the urine or blood:
____________________________________
14. Cells are scraped from the cervix or vagina for
microscopic
analysis:____________________________________
15. Removal of internal gynecologic organs and
adjacent structures in the
pelvis:____________________________________
K Give medical terms for the following definitions.
Pay careful a ention to spelling.
1. benign muscle tumors in the uterus
____________________________________
2. no menses
_____________________________________
3. removal of an ovary
_____________________________________
4. condition of female breasts (in a male)
_____________________________________
5. ovarian hormone that sustains pregnancy
_____________________________________
6. nipple-shaped elevation on the breast
_________________________________
L Match the obstetric and neonatal terms with the
descriptions that follow.
• abortion
• Apgar score
527
• cephalic version
• cesarean section
• fetal monitoring
• fetal presentation
• fontanelle
• infant respiratory distress syndrome
• hemolytic disease of the newborn
• hydrocephalus
• in vitro fertilization
• meconium aspiration syndrome
• pyloric stenosis
1. Turning the fetus so that the head presents during
birth _________________________________
2. The soft spot between the newborn's cranial bones
_____________________________________
3. The evaluation of the newborn's physical condition
_____________________________________
4. Premature termination of pregnancy
_____________________________________
5. Removal of the fetus by abdominal incision of the
uterus ___________________________
6. Acute lung disease in the premature newborn:
surfactant deficiency ____________________
7. Use of a machine to electronically record fetal heart
rate during labor ______________________
8. Narrowing of the opening of the stomach to the
small intestine in the infant ___________
9. Rh factor incompatibility between the mother and
fetus _____________________________________
528
10. Accumulation of fluid in the spaces of a neonate's
brain _________________________
11. Manner in which the fetus appears to the
examiner during delivery
_______________________
12. Thick, sticky green-black substance is discharged
into the amniotic fluid, causing fetal lung problems
_______________________
13. Union of the egg and sperm cell in a laboratory
dish
___________________________________________
M Give the meanings of the abbreviations in Column
I. Then select the le er of the correct description
from Column II.
COLUMN I
1. CIS
__________________________
2. FSH
__________________________
3. D&C
__________________________
4. multip ___________________
5. C-section
__________________
6. IVF
__________________________
7. Cx
__________________________
8. TAH-BSO _______________
9. primip ___________________
10. OB ___________________
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
COLUMN II
A. This woman has given birth to more than one infant.
B. Egg and sperm cells are combined outside the body.
C. This woman has given birth for the first time.
D. Secretion from the pituitary gland stimulates the
ovaries.
E. This procedure helps diagnose uterine disease.
F. Localized cancer growth.
G. Surgical procedure to remove the uterus, fallopian
tubes, and ovaries.
H. Surgical delivery of an infant through an abdominal
incision.
I. Branch of medicine dealing with pregnancy and
delivery of infants.
J. Lower, neck-like region of the uterus.
N Match the following abbreviations in Column I
with the best description in Column II.
529
COLUMN I
1. Pap test
2. HSG
3. AB
4. HPV
5. DCIS
6. HRT
_______
_______
_______
_______
_______
_______
COLUMN II
A. Precancerous lesion in the breast
B. X-ray record of the uterus and fallopian tubes
C. Hormones given to menopausal women
D. Diagnoses cervical and vaginal cancer
E. Termination of pregnancy; spontaneous or induced
F. Cause of cervical cancer
O Circle the term in parentheses that best completes
the meaning of each sentence.
1. Dr. Hanson felt that it was important to do a
(culdocentesis, Pap test, amniocentesis) once
yearly on each of her GYN patients to screen for
abnormal cells.
2. When Doris missed her period, her doctor checked
for the presence of (LH, IUD, hCG) in Doris's urine
to see if she was pregnant.
3. Ellen was 34 weeks pregnant and experiencing bad
headaches and blurry vision, with a 10-pound
weight gain in 2 days. Dr. Murphy told her to go to
the obstetric emergency department because she
suspected (preeclampsia, pelvic inflammatory
disease, fibroids).
4. Fifty-two-year-old Sally noticed increasing pain,
fullness, and swelling in her abdomen. She had a
history of ovarian cancer, so her physician
recommended (sentinel node biopsy, pelvic
ultrasonography, colposcopy).
5. Clara knew that she should not ignore her fevers
and yellow vaginal discharge and the pain in her
side. She had previous episodes of (PMS, PID,
HRT) treated with IV antibiotics. She worried that
she might have a recurrence.
6. After years of trying to become pregnant, Jill
decided to speak to her (hematologist,
530
gynecologist, urologist) about in vitro (gestation,
parturition, fertilization).
7. To harvest her ova, Jill's physician prescribed
hormones to stimulate egg maturation and (coitus,
lactation, ovulation). Ova were surgically removed
and fertilized with sperm cells in a Petri dish.
8. Next, multiple embryos were implanted into Jill's
(fallopian tube, vagina, uterus), and she received
hormones to ensure the survival of at least one
embryo.
9. The IVF was successful and after (abdominal CT,
ultrasound examination), Jill was told that she
would have twins in
months.
10. At 37 weeks, Jill went into labor. Under
continuous (chorionic villus sampling,
culdocentesis, fetal monitoring), two healthy
infants were delivered vaginally.
11. At age 41, Carol had a screening
(hysterosalpingogram, mammogram, conization)
of her breasts. The results showed tiny calcium
deposits, or calcifications, behind her (areola,
chorion, adnexa uteri). A core needle
(laparoscopy, colposcopy, biopsy) was performed
and showed cells that were an early sign of cancer
called (CIN, DCIS, DUB). Her surgical oncologist
recommended (lumpectomy, TAH-BSO, chorionic
villus sampling) to remove the calcifications and
surrounding tissue as treatment.
531
Answers to Exercises
A
1. endometrium
2. perineum
3. areola
4. fimbriae
5. fallopian tubes
6. clitoris
7. mammary papilla
8. placenta
9. cervix
10. amnion
11. chorion
12. perimetrium
13. labia
14. ovaries
15. vulva
16. vagina
B
1. embryo from the third month (after 8 weeks) to birth
2. tubes that carry milk within the breast
3. sex cells; the egg and sperm cells
532
4. organs (ovaries and testes) in the female and male
that produce gametes
5. ovaries, fallopian tubes, and supporting ligaments
(accessory parts of the uterus)
6. region of the abdomen between the rectum and the
uterus
7. reproductive organs (genitals)
8. small exocrine glands at the vaginal orifice that
secrete a lubricating fluid
9. developing sac in the ovary that encloses the ovum
10. empty follicle that secretes progesterone after
ovulation
C
1. estrogen
2. follicle-stimulating hormone
3. coitus
4. prenatal
5. menarche
6. human chorionic gonadotropin
7. myometrium
8. progesterone
9. luteinizing hormone
10. fertilization
D
533
1. milk
2. vagina
3. breast
4. uterus
5. ovary
6. egg
7. in, within
8. pregnancy
9. fallopian tube
10. vulva (external female genitalia)
E
1. neonatology
2. oxytocin
3. lactation
4. total hysterectomy
5. cervicitis
6. obstetrics
7. chorion
8. bilateral salpingo-oophorectomy
9. vulvovaginitis
10. culdocentesis
F
1. no menstrual flow
534
2. painful menstrual flow
3. white discharge (normally from the vagina and also
associated with cervicitis)
4. bleeding from the uterus at irregular intervals
5. abnormal discharge of milk from the breasts
6. profuse or prolonged menstrual periods occurring at
regular intervals
7. pus in the fallopian (uterine) tubes
8. painful sexual intercourse
9. heavy bleeding at and between menstrual periods
10. scanty menstrual flow
G
1. False. Total hysterectomy means removal of the entire
uterus so that menstruation does not occur.
2. True. Total hysterectomy does not mean that the
ovaries have been removed.
3. True. Birth control pills contain estrogen and
progesterone; high levels prevent ovulation and
pregnancy.
4. True. This may be necessary to treat symptoms of
estrogen loss (vaginal atrophy, hot flashes) and to
prevent bone deterioration (osteoporosis).
5. False. HPV does produce genital warts but not
ovarian cancer. In some cases, HPV infection may
lead to cervical cancer.
535
6. True. A Pap test can detect abnormal changes in the
cervix from cervical dysplasia to cervical
intraepithelial neoplasia (CIN) and CIS (carcinoma in
situ).
7. False. The hormone hCG is produced by the placenta
during pregnancy.
8. False. Gynecomastia is a condition of increased breast
development in males.
9. False. Myomectomy means removal of muscle tumors
(fibroids). Endometriosis is abnormal location of
uterine tissue outside the uterine lining.
10. False. A gravida 3 para 2 is a woman who has had
two children and three pregnancies.
11. False. A nulligravida has had no pregnancies. A
multigravida has had many pregnancies.
12. False. A pseudocyesis is a false pregnancy (no
pregnancy occurs), and a tubal pregnancy is an
example of ectopic pregnancy (pregnancy occurs in
the fallopian tube, not in the uterus).
13. False. Fibrocystic changes in the breast are a benign
condition.
14. True. Cystadenomas are glandular sacs lined with
tumor cells; they occur in the ovaries.
15. False. FSH and LH are pituitary gland hormones.
Estrogen and progesterone are secreted by the
ovaries.
H
1. act of giving birth
536
2. gradual ending of menstrual function
3. beginning of the first menstrual period at puberty
4. release of the ovum from the ovary
5. pregnancy
6. pertaining to no ovulation (egg is not released from
the ovary)
7. widening
8. natural secretion of milk
9. a woman who has never given birth
10. inflammation of the ovaries
11. inflammation of Bartholin glands
12. pain in the vulva
I
1. cystadenocarcinoma
2. cervicitis
3. preeclampsia
4. endometriosis
5. abruptio placentae
6. placenta previa
7. multiple gestations
8. cervical cancer
9. endometrial cancer
10. leiomyoma
537
J
1. cauterization
2. hysterosalpingography
3. cryosurgery or cryocauterization
4. colposcopy
5. dilation (dilatation) and cure age
6. fine needle aspiration
7. mammography
8. conization
9. culdocentesis
10. pelvic ultrasonography
11. tubal ligation
12. laparoscopy
13. pregnancy test
14. Pap test
15. pelvic exenteration
K
1. fibroids or leiomyomata
2. amenorrhea
3. oophorectomy
4. gynecomastia
5. progesterone
6. mammary papilla
538
L
1. cephalic version
2. fontanelle
3. Apgar score
4. abortion
5. cesarean section
6. infant respiratory distress syndrome
7. fetal monitoring
8. pyloric stenosis
9. hemolytic disease of the newborn
10. hydrocephalus
11. fetal presentation
12. meconium aspiration syndrome
13. in vitro fertilization
M
1. carcinoma in situ: F
2. follicle-stimulating hormone: D
3. dilation (dilatation) and cure age: E
4. multipara: A
5. cesarean section: H
6. in vitro fertilization: B
7. cervix: J
539
8. total abdominal hysterectomy with bilateral salpingooophorectomy: G
9. primipara: C
10. obstetrics: I
N
1. D
2. B
3. E
4. F
5. A
6. C
O
1. Pap test
2. hCG
3. preeclampsia
4. pelvic ultrasonography
5. PID
6. gynecologist; fertilization
7. ovulation
8. uterus
9. ultrasound examination
10. fetal monitoring
11. mammogram; areola; biopsy; DCIS; lumpectomy
540
Answers to Practical Applications
Operating Room Schedule
1. A
2. F
3. C
4. B
5. E
6. D
Pronunciation of Terms
The terms you have learned in this chapter are presented here with
their pronunciations. The meanings for all the terms are in the MiniDictionary beginning on page 897. You can also hear each term
pronounced on the Evolve website
(h p://evolve.elsevier.com/Chabner/language/).
Vocabulary and Terminology
541
TERM
adnexa uteri
amenorrhea
amniocentesis
amnion
amniotic fluid
anovulatory
areola
Bartholin glands
bartholinitis
cephalic version
cervix
chorion
chorionic
clitoris
coitus
colposcopy
corpus luteum
cul-de-sac
culdocentesis
dysmenorrhea
dyspareunia
dystocia
embryo
endocervicitis
endometritis
endometrium
episiotomy
estrogen
fallopian tube
fertilization
fetal presentation
fetus
fimbriae
follicle-stimulating hormone
galactorrhea
gamete
genitalia
gestation
gonad
gynecology
gynecomastia
human chorionic gonadotropin
hymen
hysterectomy
hysteroscopy
inframammary
intrauterine device
involution
labia
lactation
lactiferous ducts
leukorrhea
PRONUNCIATION
ad-NEK-sah U-ter-i
a-men-o-RE-ah
am-ne-o-sen-TE-sis
AM-ne-on
am-ne-OT-ik FLU-id
an-OV-u-lah-tor-e
ah-re-O-lah
BAR-tho-lin glandz
bar-tho-lih-NI-tis
seh-FAL-ik VER-zhun
SER-viks
KOR-e-on
kor-e-ON-ik
KLIH-tor-is
KO-it-us
kol-POS-ko-pe
KOR-pus LU-te-um
KUL-deh-sak
kul-do-sen-TE-sis
dis-men-o-RE-ah
dis-pah-RU-ne-ah
dis-TO-se-ah
EM-bre-o
en-do-ser-vih-SI-tis
en-do-meh-TRI-tis
en-do-ME-tre-um
eh-pe-ze-OT-o-me
ES-tro-jen
fah-LO-pe-an toob
fer-tih-lih-ZA-shun
FE-tal pres-en-TA-shun
FE-tus
FIM-bre-e
FOL-lik-il STIM-u-la-ting HOR-mone
gah-lak-to-RE-ah
GAM-eet
jeh-nih-TA-le-ah
jes-TA-shun
GO-nad
gi-neh-KOL-o-je
gi-neh-ko-MAS-te-ah
HU-man ko-re-ON- ik go-nad-o-TRO-pin
HI-men
his-ter-EK-to-me
his-ter-OS-ko-pe
in-frah-MAM-ar-e
in-trah-U-ter-in de-VISE
in-vo-LU-shun
LA-be-ah
lak-TA-shun
lak-TIH-fer-us dukts
lu-ko-RE-ah
542
TERM
luteinizing hormone
mammary papilla
mammoplasty
mastectomy
mastitis
menarche
menometrorrhagia
menopause
menorrhagia
menorrhea
menstruation
metrorrhagia
multigravida
multipara
myomectomy
myometrium
neonatal
neonatology
nulligravida
nullipara
obstetrics
oligomenorrhea
oocyte
oogenesis
oophorectomy
oophoritis
orifice
ovarian
ovarian follicle
ovary
ovulation
ovum; pl. ova
oxytocia
oxytocin
parturition
perimetrium
perineorrhaphy
perineum
pituitary gland
placenta
pregnancy
prenatal
primigravida
primipara
primiparous
progesterone
pseudocyesis
puberty
pyosalpinx
retroversion
salpingectomy
salpingitis
PRONUNCIATION
LU-teh-ni-zing HOR-mone
MAH-meh-re pah-PIL-ah
MAH-mo-plas-te
mah-STEK-to-me
mah-STI-tis
meh-NAR-ke
meh-no-meh-tro-RA-jah
MEN-o-pawz
men-o-RA-jah
men-o-RE-ah
men-stru-A-shun
met-ro-RA-jah
mul-tih-GRAV-ih-dah
mul-TIH-pah-rah
mi-o-MEK-to-me
mi-o-ME-tre-um
ne-o-NA-tal
ne-o-na-TOL-o-je
nul-leh-GRAV-ih-dah
nul-LIH-pah-rah
ob-STET-riks
ol-ig-o-men-o-RE-ah
o-o-SITE
o-o-JEN-eh-sis
oo-fo-REK-to-me
oo-fo-RI-tis
OR-ih-fis
o-VAH-re-an
o-VAH-re-an FOL-ih-kil
O-vah-re
ov-u-LA-shun
O-vum; O-va
ox-e-TO-se-ah
ox-se-TO-sin
par-tu-RIH-shun
peh-rih-ME-tre-um
peh-rih-ne-OR-ah-fe
peh-rih-NE-um
pih-TU-ih-tah-re gland
plah-SEN-tah
PREG-nan-se
pre-NA-tal
prih-mih-GRAV-ih-dah
prih-MIP-ah-rah
prih-MIP-pah-rus
pro-JES-teh-rone
su-do-si-E-sis
PU-ber-te
pi-o-SAL-pinks
re-tro-VER-zhun
sal-pin-JEK-to-me
sal-pin-JI-tis
543
TERM
uterine prolapse
uterus
vagina
vaginal orifice
vaginitis
vulva
vulvodynia
vulvovaginitis
zygote
PRONUNCIATION
U-teh-rin PRO-laps
U-ter-us
vah-JI-nah
VAH-jih-nal OR-ih-fis
vah-jih-NI-tis
VUL-vah
vul-vo-DIH-ne-ah
vul-vo-vah-jih-NI-tis
ZI-gote
Pathologic Conditions, Clinical Tests, and Procedures
544
TERM
abortion
abruptio placentae
Apgar score
breast cancer
carcinoma in situ
cauterization
cesarean section
cervical cancer
cervical dysplasia
cervicitis
choriocarcinoma
chorionic villus sampling
colposcopy
conization
cryosurgery
culdocentesis
dermoid cysts
dilatation
dilation and cure age
Down syndrome
ectopic preganancy
endometrial cancer
endometriosis
exenteration
fetal monitoring
fibrocystic breast disease
fibroids
fine needle aspiration
hemolytic disease of the newborn
hydrocephalus
hysterosalpingography
in vitro fertilizaiton
infant respiratory distress syndrome
laparoscopy
leiomyomas
mammography
meconium aspiration syndrome
multiple gestation
ovarian cancer
ovarian cysts
palpation
Pap test
pelvic inflammatory disease
pelvic ultrasonography
placenta previa
preeclampsia
pregnancy test
pyloric stenosis
tubal ligation
PRONUNCIATION
ah-BOR-shun
ah-BRUP-se-o plah-SEN-ta
AP-gar score
brest KAN-ser
kar-sih-NO-mah in SI-tu
kaw-ter-ih-ZA-shun
seh-ZAH-re-an SEK-shun
SER-vih-kul KAN-ser
SER-vih-kul dis-PLA-ze-ah
ser-vih-SI-tis
ko-re-o-kar-sih-NO-mah
ko-re-ON-ik VIL-us SAMP-ling
kol-POS-ko-pe
ko-nih-ZA-shun
kri-o-SUR-jer-e
kul-do-sen-TE-sis
DER-moyd sists
dih-lah-TA-shun
di-LA-shun & kur-eh-TAZH
Down SIN-drohm
ek-TOP-ik PREG-nan-se
en-do-ME-tre-al KAN-ser
en-do-me-tre-O-sis
eks-en-teh-RA-shun
FE-tal MON-it-or-ing
fi-bro-SIS-tik brest dih-ZEEZ
FI-broydz
fine NE-dil as-pih-RA-shun
he-mo-LIH-tic dih-ZEEZ of the nu-born
hi-dro-SEF-ah-lus
his-ter-o-sal-ping-OG-rah-fe
in VE-tro fer-til-ih-ZA-shun
IN-fant RES-pih-rah-tor-e dis-TRES SIN-drohm
lap-ah-ROS-ko-pe
li-o-mi-O-maz
mah-MOG-rah-fe
meh-KO-ne-um as-pih-RA-shun SIN-drohm
MUL-tih-pel jes-TA-shun
o-VAH-re-an KAN-ser
o-VAH-re-an sists
pal-PA-shun
pap test
PEL-vik in-FLAM-mah-tor-e dih-ZEEZ
PEL-vic
ul-trah-son-OG-rah-fe
plah-sen-tah PREH-ve-ah
pre-e-KLAMP-se-ah
PREG-nan-se test
pi-LOR-ik steh-NO-sis
TOOB-al li-GA-shun
545
Review Sheet
Write the meanings of the word parts in the spaces provided, and test
yourself. Check your answers with the information in the chapter or in
the Glossary (Medical Word Parts—English) at the end of the book.
Combining Forms
COMBINING FORM
amni/o
bartholin/o
cephal/o
cervic/o
chori/o, chorion/o
colp/o
culd/o
episi/o
galact/o
gynec/o
hyster/o
lact/o
mamm/o, mast/o
men/o
metr/o, metri/o
my/o, myom/o
nat/i
obstetr/o
olig/o
o/o, ov/o, ovul/o
oophor/o, ovari/o
perine/o
phor/o
py/o
salping/o
uter/o
vagin/o
vulv/o
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Prefixes
546
PREFIX
bidysendoinintramultinullioxyperipreprimipseudoretrouni-
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Suffixes
SUFFIX
-arche
-cyesis
-dynia
-ectomy
-flexion
-genesis
-gravida
-itis
-pareunia
-parous
-plasia
-plasty
-rrhagia
-rrhaphy
-rrhea
-salpinx
-scopy
-stenosis
-stomy
-tocia, -tocin
-tomy
-version
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Diagnostic Procedures
Match the diagnostic procedures in Column I with their descriptions in
Column II. Check your answers with the information in the chapter.
547
COLUMN I
1. fine needle aspiration
2. colposcopy
3. culdocentesis
4.
hysterosalpingograph
y
5. mammography
6. Pap test
7. pregnancy test
8. pelvic
ultrasonography
_______
_______
_______
_______
_______
_______
_______
_______
COLUMN II
A. Uterus and fallopian tubes are imaged (x-ray
procedure).
B. hCG is measured.
C. X-ray images are taken of the breast.
D. Procedure to biopsy breast tissue.
E. Removal of cervical and vaginal cells for analysis.
F. Fluid is obtained from the region between the rectum
and the uterus.
G. Images of the region of the hip are obtained using
sound waves.
H. Microscopic visual examination of the vagina and
cervix.
548
CHAPTER 9
549
Male Reproductive System
CHAPTER SECTIONS:
Introduction 292
Anatomy 293
Vocabulary 295
Terminology 297
Pathologic Conditions; Sexually Transmitted Diseases 299
Laboratory Tests and Clinical Procedures 304
Abbreviations 306
Practical Applications 307
In Person: Prostate Cancer 309
Exercises 310
Answers to Exercises 316
Pronunciation of Terms 318
Review Sheet 320
CHAPTER GOALS
• Name, locate, and describe the functions of the organs of the male
reproductive system.
• Define abnormal conditions and infectious diseases that affect the male
reproductive system.
• Differentiate among several types of sexually transmitted infections.
• Define combining forms used to describe the structures of this system.
• Describe various laboratory tests and clinical procedures pertinent to
disorders of the male reproductive system, and recognize related
abbreviations.
550
• Apply your new knowledge to understanding medical terms in their proper
contexts, such as medical reports and records.
551
Introduction
The male sex cell, the spermatozoon (sperm cell), is microscopic—in
volume, only one third the size of a red blood cell and less than 1/100,000
the size of the female ovum. A relatively uncomplicated cell, the sperm is
composed of a head region, containing nuclear hereditary material
(chromosomes), and a tail region, consisting of a flagellum (hair-like
process). The flagellum makes the sperm motile and makes it look
somewhat like a tadpole. The spermatozoon cell contains relatively li le
food and cytoplasm, because it lives only long enough (3 to 5 days) to
travel from its point of release from the male to where the egg cell lies
within the female reproductive tract (fallopian tube). Only one
spermatozoon out of approximately 300 million sperm cells released
during a single ejaculation (ejection of sperm and fluid from the male
urethra) can penetrate a single ovum and result in fertilization of the
ovum. Figure 9-1 shows a diagram of a sperm cell and a photograph of
spermatozoa.
FIGURE 9-1 A, Sperm cell. B, Photograph of spermatozoa.
If more than one egg is passing down the fallopian tube when sperm are
present, multiple fertilizations are possible, and twins, triplets,
quadruplets, and so on may occur. Twins resulting from the fertilization of
separate ova by separate sperm cells are called fraternal twins. Fraternal
twins, developing with separate placentas, can be of the same sex or
different sexes and resemble each other no more than ordinary brothers
and sisters. Fraternal twinning is hereditary; the daughters of mothers of
twins can carry the gene.
552
Identical twins result from fertilization of a single egg cell by a single
sperm. As the fertilized egg cell divides and forms many cells, it somehow
splits, and each part continues separately to undergo further division, each
producing an embryo. The split usually occurs between the third and fifth
days of embryonic development. Most identical twins have one placenta
and two amniotic sacs. Identical twins have the same DNA and are,
therefore, of the same sex and of very similar form and feature.
The organs of the male reproductive system are designed to produce
and release billions of spermatozoa throughout the lifetime of a male from
puberty onward. In addition, the male reproductive system secretes a
hormone called testosterone. Testosterone is responsible for the
production of the bodily characteristics of the male (such as beard, pubic
hair, and deeper voice) and for the proper development of male gonads
(testes) and accessory organs (prostate gland and seminal vesicles) that
secrete fluids to ensure the lubrication and viability of sperm.
553
Anatomy
Label Figure 9-2 as you study the following description of the anatomy of
the male reproductive system.
FIGURE 9-2 Male reproductive system, sagittal view.
Each male gonad is a testis [1]. There are two testes (plural) or testicles
that develop in the abdomen at about the level of the kidneys before
descending during embryonic development into the scrotum [2], a sac
enclosing the testes on the outside of the body.
The scrotum, lying between the thighs, exposes the testes to a lower
temperature than that of the rest of the body. This lower temperature is
necessary for the adequate maturation and development of sperm
(spermatogenesis). Located between the anus and the scrotum, at the floor
of the pelvic cavity in the male, the perineum [3] is analogous to the
perineal region in the female.
The interior of a testis is composed of a large mass of narrow, coiled
tubules called the seminiferous tubules [4]. These tubules contain cells
that manufacture spermatozoa. The seminiferous tubules are the
parenchymal tissue of the testis, which means that they perform the
essential work of the organ (formation of sperm). Other cells in the testis,
554
lying adjacent to seminiferous tubules, are interstitial cells. They
manufacture an important male hormone, testosterone.
All body organs contain parenchyma, which perform the essential
functions of the organ. Organs also contain supportive, connective, and
framework tissue, such as blood vessels, connective tissues, and
sometimes muscle as well. This supportive tissue is called stroma (stromal
tissue).
After formation, sperm cells move through the seminiferous tubules and
collect in ducts that lead to a large tube, the epididymis [5], at the upper
part of each testis. The spermatozoa mature, become motile in the
epididymis, and are temporarily stored there. An epididymis runs down
the length of each testicle (the coiled tube is about 16 feet long) and then
turns upward again and becomes a narrow, straight tube called the vas
deferens [6] or ductus deferens. Figure 9-3 shows the internal structure of
a testis and the epididymis. The vas deferens is about 2 feet long and
carries the sperm up into the pelvic region, at the level of the urinary
bladder, merging with ducts from the seminal vesicles [7] to form the
ejaculatory duct [8] leading toward the urethra. During a vasectomy or
sterilization procedure, the urologist cuts and ties off each vas deferens by
making an incision in the scrotum.
FIGURE 9-3 Internal structure of a testis and the epididymis.
The seminal vesicles, two glands (only one is shown in Figure 9-2)
located at the base of the bladder, open into the ejaculatory duct as it joins
the urethra [9]. They secrete a thick, sugary, yellowish substance that
nourishes the sperm cells and forms a portion of ejaculated semen. Semen,
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a combination of fluid (seminal fluid) and spermatozoa (sperm cells
account for less than 1% of the semen volume), is ejected from the body
through the urethra. In the male, as opposed to that in the female, the
genital orifice combines with the urinary (urethral) opening.
The prostate gland [10] lies at the region where the vas deferens enters
the urethra, almost encircling the upper end of the urethra. It secretes a
milky white fluid that is a mixture of sugars, enzymes, and alkaline
chemicals. As part of semen, this fluid is nutritious for sperm cells, and
after ejaculation into the vagina, the alkaline chemicals promote the
survival of sperm in the acidic environment of the vagina. Muscular tissue
of the prostate aids in the expulsion of fluid during ejaculation.
Bulbourethral glands [11], lying below the prostate gland, also secrete
fluid into the urethra during ejaculation.
The urethra passes through the penis [12] to the outside of the body.
The penis is composed of erectile tissue and at its tip expands to form a
soft, sensitive region called the glans penis [13]. Ordinarily, a fold of skin
called the prepuce, or foreskin [14], covers the glans penis. The foreskin is
a ached to glans penis in uncircumcised babies. Between 2 and 10 years of
age, the foreskin naturally detaches and can be pulled back from the head
of the penis. If an infant is circumcised, the foreskin is removed, leaving
the glans penis visible at all times.
Erectile dysfunction (impotence) is the inability of the adult male to
achieve an erection. Viagra (sildenafil), Cialis (tadalafil), and Stendra
(avanafil) are drugs that increase blood flow to the penis, enhancing ability
to have an erection. Male infertility is any problem in a man that lowers
the chances of his female partner ge ing pregnant.
The flow diagram in Figure 9-4 traces the path of spermatozoa from
their formation in the seminiferous tubules of the testes to the outside of
the body.
556
FIGURE 9-4 The passage of sperm from the seminiferous tubules
in the testes to the outside of the body.
Vocabulary
This list reviews new terms introduced in the text. Short definitions
reinforce your understanding.
557
bulbourethral Pair of exocrine glands near the male urethra. They secrete fluid into the
glands
urethra. Also called Cowper glands.
circumcision Removal of the prepuce (foreskin). It is a common elective procedure
performed shortly after birth.
ejaculation
Ejection of sperm and fluid from the male urethra.
ejaculatory
Tube through which semen enters the male urethra.
duct
epididymis
One of a pair of long, tightly coiled tubes above each testis. It stores and
(plural:
carries sperm from seminiferous tubules to the vas deferens.
epididymides)
erectile
Inability of an adult male to achieve an erection; impotence.
dysfunction
flagellum
Hair-like projection on a sperm cell that makes it motile (able to move).
foreskin
Fold of skin covering the head of the penis; prepuce.
fraternal
Two infants resulting from fertilization of two separate ova by two separate
twins
sperm cells (Figure 9-5).
glans penis
Sensitive tip of the penis; comparable to the clitoris in the female.
identical
Two infants resulting from division of one fertilized egg. Conjoined
twins
(“Siamese”) twins are incompletely separated identical twins.
infertility
In a man, any problem that lowers the chances of his female partner ge ing
pregnant.
interstitial
Specialized cells that lie adjacent to the seminiferous tubules in the testes.
cells of the
These cells produce testosterone and are also called Leydig cells.
testes
parenchymal Essential distinctive cells of an organ. In the testis, the seminiferous tubules
tissue
that produce sperm are parenchymal.
penis
Male external organ of reproduction.
perineum
External region between the anus and scrotum in the male.
prepuce
Foreskin; fold of skin covering the tip of the penis.
prostate gland Exocrine gland at the base of the male urinary bladder. The prostate secretes
fluid that contributes to semen during ejaculation. HINT: Don't confuse
prostate with prostrate, which means lying down.
scrotum
External sac that contains the testes.
semen
Spermatozoa (sperm cells) and seminal fluid (prostatic and seminal vesicle
secretions), discharged from the urethra during ejaculation.
seminal
Paired sac-like exocrine glands that secrete fluid (a major component of
vesicles
semen) into the vas deferens.
seminiferous Narrow, coiled tubules that produce sperm in the testes.
tubules
spermatozoon Sperm cell.
(plural:
spermatozoa)
sterilization
Procedure that removes a person's ability to produce or release reproductive
cells; removal of testicles, vasectomy, and oophorectomy are sterilization
procedures.
stromal tissue Supportive, connective tissue of an organ, as distinguished from its
parenchyma. Also called stroma.
testis (plural: Male gonad (testicle) that produces spermatozoa and testosterone. Remember:
testes)
Testis means one testicle, and testes are two testicles.
testosterone
Hormone secreted by the interstitial tissue of the testes; responsible for male
sex characteristics.
vas deferens
Narrow tube (one on each side) carrying sperm from the epididymis toward
the urethra. Also called ductus deferens.
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FIGURE 9-5 Fraternal twins. A, Notice the 6-week-old embryos in
two separate amniotic sacs. B, Twins Marcos and Matheus Do
Carmo are 16 years old. (Courtesy Juliana Do Carmo.)
Perineum/Peritoneum
Don't confuse perineum, which is the area between the anus and scrotum
in the male and the anus and vagina in females, with the peritoneum,
which is the membrane surrounding the abdominal cavity!
Semen/Sperm
Don't confuse semen with sperm. Semen is the thick, whitish secretion
discharged from the urethra during ejaculation. Sperm (spermatozoa) are
cells that develop in the testes. Semen contains sperm.
Sterilization/Impotence
Don't confuse sterilization, which can be performed in men and women,
with impotence, which is the inability of a male to sustain an erection or
achieve ejaculation.
Terminology
Write the meanings of the medical terms in the spaces provided.
Combining Forms
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COMBINING
MEANING
FORM
andr/o
male
balan/o
cry/o
glans penis
(Greek
balanos,
means acorn)
cold
crypt/o
hidden
epididym/o
epididymis
gon/o
seed (Greek
gone, seed)
water, fluid
hydr/o
orch/o,
orchi/o,
orchid/o
testis, testicle
pen/o
penis
prostat/o
prostate
gland
semin/i
semen, seed
sperm/o,
spermat/o
spermatozoa,
semen
terat/o
monster
(Greek teras,
monster)
test/o
testis, testicle
TERMINOLOGY
MEANING
androgen _______________________________________
Testosterone is an androgen. The testes in males and the adrenal
glands in both men and women produce androgens.
balanitis ________________________________________
An inflammation usually caused by overgrowth of organisms
(bacteria and yeast) (Figure 9-6A).
cryogenic surgery _________________________________
Technique for prostate cancer treatment using freezing
temperatures to destroy cancer cells.
cryptorchidism ___________________________________
In this congenital condition, one or both testicles do not descend,
by the time of birth, into the scrotal sac from the abdominal cavity
(Figure 9-6B).
epididymitis _____________________________________
This is an inflammation usually caused by bacteria. Signs and
symptoms are fever, chills, pain in the groin, and tender, swollen
epididymis.
gonorrhea _______________________________________
See page 302.
hydrocele _______________________________________
See page 300.
orchiectomy _____________________________________
Castration in males. (Also called orchidectomy.)
orchitis _________________________________________
Caused by injury or by the mumps virus, which also infects the
salivary glands.
penile __________________________________________
-ile means pertaining to.
penoscrotal _____________________________________
prostatitis ______________________________________
Bacterial (E. coli) prostatitis often is associated with urethritis
and infection of the lower urinary tract.
prostatectomy ___________________________________
Robotic assisted laparoscopic prostatectomy (RALP) is a
treatment option for prostate removal.
seminiferous tubules ______________________________
The suffix -ferous means pertaining to bearing, or bearing or
carrying.
spermolytic _____________________________________
Noun suffixes ending in -sis, such as -lysis, form adjectives by
dropping the -sis and adding -tic.
oligospermia ____________________________________
aspermia _______________________________________
Lack of semen (sperm and fluid). One cause of aspermia is
retrograde ejaculation (sperm flows backward into the urinary
bladder) as a result of prostate surgery.
teratoma _______________________________________
This tumor occurs in the testes or ovaries and is composed of
different types of tissue, such as bone, hair, cartilage, and skin
cells. Teratomas in the testes are malignant.
testicular _______________________________________
The term testis originates from a Latin term meaning witness. In
ancient times men would take an oath with one hand on their
testes, swearing by their manhood to tell the truth.
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COMBINING
MEANING
FORM
varic/o
varicose
veins
vas/o
vessel, duct;
vas deferens
zo/o
animal life
TERMINOLOGY
MEANING
varicocele ______________________________________
Collection of varicose (swollen, twisted) veins above the testis. See
page 300.
vasectomy ______________________________________
See page 306. Remember: In this term, vas/o refers to the vas
deferens, and not to any other vessel or duct.
azoospermia _________________________
Lack of spermatozoa in the semen. Causes include testicular
dysfunction, chemotherapy, blockage of the epididymis, and
vasectomy. HINT: Azoospermia is semen without sperm,
while aspermia is no semen at all.
FIGURE 9-6 A, Balanitis. The glans penis (or glans) is the
sensitive bulbous area at the distal end of the penis. B,
Cryptorchidism.
Suffixes
SUFFIX MEANING TERMINOLOGY
MEANING
formation
spermatogenesis _________________________________
genesis
-one
hormone
testosterone ____________________________________
Ster/o indicates that this is a type of steroid compound. Examples of other
steroids are estrogen, cortisol, and progesterone.
-pexy
fixation, put
orchiopexy ______________________________________
in place
A surgical procedure to correct cryptorchidism.
-stomy new
vasovasostomy __________________________________
opening
Reversal of vasectomy; a urologist rejoins the cut ends of the vas deferens.
Derivation of orchid/o
This combining form is derived from the Greek word orchis, meaning
testicle. The botanical name for orchid, the flower, is also derived from the
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same Greek word because of the fleshy tubers of the plant.
Azoospermia and Infertility
Male factor infertility is the cause of up to 40% of infertility issues. The
most common causes of male infertility are azoospermia and
oligoasthenozoospermia (low numbers and poor motility of sperm). The
combining form asthen/o means lack of strength.
562
Pathologic Conditions; Sexually
Transmitted Infections
Tumors and Anatomic/Structural Disorders
Testes
testicular
cancer
(carcinoma of
the testes)
Malignant tumor of the testicles.
Testicular tumors are rare except in the 15- to 35-year-old age group. The
most common tumor, a seminoma, arises from embryonic cells in the
testes (Figure 9-7A). Other tumors are embryonal carcinoma (Figure 97B), teratoma, choriocarcinoma, and yolk sac tumor. Teratomas contain
a mixture of mature tissue such as bone, hair, cartilage, and skin cells
(terat/o means monster).
Testicular cancers are curable with surgery (orchiectomy), followed by
chemotherapy. Seminomas are treated with radiotherapy and/or
chemotherapy. Tumors produce the proteins human chorionic gonadotropin
(hCG) and alpha-fetoprotein (AFP). Serum levels of these proteins are used
as tumor markers to determine success of treatment.
cryptorchidism;
Undescended testicles.
cryptorchism
Orchiopexy is performed to bring the testes into the scrotum, if they do
not descend on their own by the age of 1 or 2 years. Undescended
testicles are associated with a high risk for sterility and increased risk of
developing testicular cancer.
hydrocele
Sac of clear fluid in the scrotum.
Hydroceles (Figure 9-8) may be congenital or occur as a response to
infection or tumors. Often idiopathic, they can be differentiated from
testicular masses by ultrasound imaging. If the hydrocele does not
resolve on its own, the sac fluid is aspirated using a needle and syringe,
or hydrocelectomy may be necessary. In this procedure, the sac is
surgically removed through an incision in the scrotum.
testicular
Twisting of the spermatic cord (see Figure 9-8).
torsion
The rotation of the spermatic cord cuts off blood supply to the testis.
Torsion occurs most frequently in childhood. Surgical correction within
hours of onset of symptoms can save the testis.
varicocele
Enlarged, dilated veins near the testicle.
Varicocele (see Figure 9-8) may be associated with oligospermia and
azoospermia. Oligospermic men with varicocele and scrotal pain should
have a varicocelectomy. In this procedure, the internal spermatic vein is
ligated (the affected segment is cut out and the ends are tied off). This
procedure may increase fertility.
563
FIGURE 9-7 A, Seminoma of a testis. B, Embryonal carcinoma
of a testis. In contrast with the seminoma, which is a pale,
homogeneous mass, the embryonal carcinoma is a hemorrhagic
mass.
FIGURE 9-8 Hydrocele, testicular torsion, and varicocele.
Testicular Cancer Detection
There may be no signs or symptoms of testicular cancer. Regular
testicular self-examinations, however, can help identify growths earlier,
when the chance for successful treatment is highest. A man should see a
doctor if he detects any mass, pain, or swelling in the scrotum.
Prostate Gland
564
benign
prostatic
hyperplasia
(BPH)
prostate
cancer
(carcinoma
of the
prostate)
Benign growth of cells within the prostate gland.
BPH is a common condition in men older than 60 years of age. Urinary
obstruction and inability to empty the bladder completely are symptoms.
Figure 9-9 shows the prostate gland with BPH and with carcinoma. Surgical
treatment by transurethral resection of the prostate (TURP) relieves the
obstruction, but overgrowth of cells may recur over several years. In this
procedure, an endoscope (resectoscope) is inserted into the penis and
through the urethra. Prostatic tissue is removed by an electrical hot loop
a ached to the resectoscope (see page 305).
Several drugs to relieve BPH symptoms have been approved by the FDA.
Finasteride (Proscar) inhibits production of a potent testosterone that
promotes enlargement of the prostate. Other drugs, alpha blockers such as
tamsulosin (Flomax), act by relaxing the smooth muscle of the prostate and
the neck of the bladder.
Lasers also may be used to destroy prostatic tissue and relieve obstruction. A
laser TURP or GreenLight PVP procedure uses a green light laser at the end
of an endoscope (see page 305).
Malignant tumor (adenocarcinoma) of the prostate gland.
This cancer commonly occurs in men older than 50 years. Digital rectal
examination (DRE) (Figure 9-10) can detect the tumor at a later stage, but
early detection depends on finding a high level of a prostate-specific antigen
(PSA) in the blood. PSA is secreted into the bloodstream by tumor cells. The
normal PSA level is 4.0 ng/mL or less.
Diagnosis requires finding tumor in a needle biopsy of the prostate.
Transrectal ultrasound (TRUS) guides the needle biopsy taken through the
rectal wall. Multiple needle biopsy specimens are taken through the rectal
wall. Computed tomography (CT) detects lymph node metastases.
Treatment consists of surgery (prostatectomy) or radiation therapy for
localized tumor. Hormonal therapy is used for locally advanced or metastatic
disease. Because prostatic cells are stimulated to grow in the presence of
androgens, antiandrogen drugs slow tumor growth. One such drug is
Lupron, which reduces the level of androgens in the bloodstream. Tumor
cells also can be destroyed by brachytherapy (brachy = near), which means
that radioactive seeds are implanted directly into the prostate gland. See the
In Person: Prostate Cancer story on page 309.
565
FIGURE 9-9 The prostate gland with carcinoma and benign
prostatic hyperplasia (BPH). Carcinoma usually arises around the
sides of the gland, whereas BPH occurs in the center of the gland.
Because prostate cancers are located more peripherally, they can
be palpated on digital rectal exam (DRE).
FIGURE 9-10 Digital rectal examination (DRE) of the prostate
gland.
Penis
566
hypospadias
Peyronie
disease
phimosis
Congenital abnormality in which the male urethral opening is on the
undersurface of the penis, instead of at its tip.
Hypospadias (-spadias means the condition of tearing or cu ing) occurs in 1
in every 300 live male births and can be corrected surgically (Figure 9-11A).
Abnormal curvature of the penis
This condition is quite common and is caused by scar tissue in the
connective tissue of the penis. Drug treatment can be effective by breaking
down the buildup of fibrous tissue that causes penile curvature.
Narrowing (stricture) of the opening of the prepuce over the glans penis.
This abnormal condition (phim/o = muzzle) in adolescent and adult males
can interfere with urination and cause secretions to accumulate under the
prepuce, leading to infection. Treatment is by circumcision (cu ing around
the prepuce to remove it) (Figure 9-11B).
FIGURE 9-11 A, Hypospadias. Surgical repair involves elongating
the urethra by using surrounding tissue or using a graft from tissue
elsewhere in the body and bringing it to the exit at the tip of the
penis. B, Phimosis and circumcision to correct the condition.
Sexually Transmitted Infections
Sexually transmi ed infections (STIs) are infections transmi ed by
sexual or other genital contact. Also known as sexually transmi ed
diseases (STDs) or venereal diseases (from Latin Venus, the goddess of
love), they occur in both men and women and are some of the most
prevalent communicable diseases in the world.
567
chlamydia
gonorrhea
herpes
genitalis
human
papillomavirus
(HPV)
infection
syphilis
Bacterial infection (by Chlamydia trachomatis) of the urethra and
reproductive tract.
Within 3 weeks after becoming infected, men may experience a burning
sensation on urination and notice a white or clear discharge from the
penis.
Infected women may notice a yellowish vaginal discharge (from the
endocervix), but often the disease is asymptomatic. Antibiotics cure the
infection, but if untreated, this STI can cause salpingitis (pelvic
inflammatory disease [PID]) and infertility in women.
Inflammation of the genital tract mucosa, caused by infection with
gonococci (berry-shaped bacteria).
Other areas of the body, such as the eye, oral mucosa, rectum, and joints,
may be affected as well. Signs and symptoms include dysuria and a
yellow, mucopurulent (purulent means pus-filled) discharge from the
male urethra (Figure 9-12A). The ancient Greeks mistakenly thought that
this discharge was a leakage of semen, so they named the condition
gonorrhea, meaning discharge of seed (gon/o = seed).
Many women carry the disease asymptomatically, whereas others have
pain, vaginal and urethral discharge, and salpingitis (PID). As a result of
sexual activity, men and women can acquire anorectal and pharyngeal
gonococcal infections as well. Chlamydia and gonorrhea often occur
together. When treating these infections, doctors give antibiotics for both
and treat both partners.
Infection of skin and genital mucosa, caused by the herpes simplex
virus (HSV).
Most cases of herpes genitalis are caused by HSV type 2 (although some
are caused by HSV type 1, which commonly is associated with oral
infections such as cold sores or fever blisters). The usual clinical
presentation is reddening of skin with formation of small, fluid-filled
blisters and ulcers (Figure 9-12B). Initial episodes also may involve
inguinal lymphadenopathy, fever, headache, and malaise. Remissions
and relapse periods occur; no drug is known to be effective as a cure.
Neonatal herpes affects infants born to women with active infection near
the time of delivery. Gynecologists may deliver infants by cesarean
section to prevent infection of these babies by HSV. Studies suggest that
women with herpes genitalis are at a higher risk for developing vulvar
and cervical cancer.
Infection of the skin and mucous membranes in the anogenital region
by the human papillomavirus.
Some types of HPV cause genital warts (see Figure 9-13A) and lead to
cancer of the cervix as well as cancer in men. A vaccine is available for
young girls and boys that protects against nine types of HPV.
Chronic STI caused by a spirochete (spiral-shaped bacterium).
A chancre (hard ulcer or sore) usually appears on the external genitalia a
few weeks after bacterial infection (Figure 9-13B). Two to six months after
the chancre disappears, secondary syphilis begins. Tertiary syphilis
includes damage to the brain, spinal cord, and heart, which may appear
years after the earlier symptoms disappear. Syphilis (which was so often
fatal in early times that it was known as the “great pox”—versus the
more familiar smallpox) can be congenital in the fetus if it is transmi ed
from the mother during pregnancy. Penicillin is effective for treatment in
most cases.
568
FIGURE 9-12 A, Gonorrhea. Discharge from the penis can be
seen. B, Herpes genitalis. The classic blisters (vesicles) are
evident.
FIGURE 9-13 A, Genital warts. B, Primary syphilis with chancre on
penis.
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Laboratory Tests and Clinical Procedures
Laboratory Tests
PSA
test
semen
analysis
Measurement of levels of prostate-specific antigen (PSA) in the blood.
PSA is produced by cells within the prostate gland. Elevated levels of PSA are
associated with enlargement of the prostate gland and may be a sign of prostate
cancer.
Microscopic examination of ejaculated fluid.
Sperm cells are counted and examined for motility and shape. The test is part of
fertility studies and is required to establish the effectiveness of vasectomy. Men
with sperm counts of less than 20 million/mL of semen usually are sterile (not
fertile). Sterility can result in an adult male who becomes ill with mumps, an
infectious disease affecting the testes (inflammation leads to deterioration of
spermatozoa).
Clinical Procedures
castration
circumcision
digital rectal
examination
(DRE)
photoselective
vaporization
of the prostate
(GreenLight
PVP)
transurethral
resection of
the prostate
(TURP)
vasectomy
Surgical excision of testicles or ovaries.
Castration may be performed to reduce production and secretion of
hormones that stimulate growth of malignant cells (in breast cancer and
prostate cancer). When a boy is castrated before puberty, he becomes a
eunuch (Greek, eune, couch; echein, to guard). Male secondary sex
characteristics fail to develop.
Surgical procedure to remove the prepuce (foreskin) of the penis.
See Figure 9-11B, page 303.
Finger palpation through the anal canal and rectum to examine the
prostate gland.
See Figure 9-10, page 301.
Removal of tissue to treat benign prostatic hyperplasia (BPH) using a
green light laser (“laser TURP”).
This minimally invasive procedure in selected cases replaces TURP for
treatment of BPH.
Removal of portions of prostate gland through the urethra.
This procedure treats benign prostatic hyperplasia (BPH). An electrical hot
loop cuts the prostatic tissue; the bits of tissue (chips) are removed
through the resectoscope (Figure 9-14).
Bilateral surgical removal of a part of the vas deferens.
A urologist cuts the vas deferens, removes a piece, and performs a ligation
(tying and binding off) of the free ends with sutures (Figure 9-15); this is
repeated on the opposite side. The procedure is performed using local
anesthesia and through an incision in the scrotal sac. Because spermatozoa
cannot leave the body, the vasectomized man is sterile, but not castrated.
Normal hormone secretion, sex drive, and potency (ability to have an
erection) are intact. The body reabsorbs unexpelled sperm. In some cases,
a vasovasostomy can successfully reverse vasectomy.
570
FIGURE 9-14 Transurethral resection of the prostate (TURP).
A, The resectoscope contains a light, valves for controlling irrigating
fluid, and an electrical loop that cuts tissue and seals blood vessels.
B, The urologist uses a wire loop through the resectoscope to
remove obstructing tissue one piece at a time. The pieces are
carried by the fluid into the bladder and flushed out at the end of the
operation.
FIGURE 9-15 Vasectomy.
Abbreviations
571
BPH
DRE
ED
GU
HPV
HSV
NSU
PID
PIN
PSA
PVP
RALP
RPR
STD
STI
TRUS
benign prostatic hyperplasia
digital rectal examination
erectile dysfunction
genitourinary
human papillomavirus
herpes simplex virus
nonspecific urethritis (not due to gonorrhea or chlamydia)
pelvic inflammatory disease
prostatic intraepithelial neoplasia; a precursor of prostate cancer
prostate-specific antigen
photoselective vaporization of the prostate; GreenLight PVP
robotic assisted laparoscopic prostatectomy
rapid plasma reagin [test]; a test for syphilis
sexually transmi ed disease
sexually transmi ed infection
transrectal ultrasound [examination]; test to assess the prostate and guide precise
placement of a biopsy needle
TUIP transurethral incision of the prostate; successful in less enlarged prostates and less
invasive than TURP
TUMT transurethral microwave thermotherapy
TUNA transurethral needle ablation; radiofrequency energy destroys prostate tissue
TURP transurethral resection of the prostate
Practical Applications
Reproduced here from actual medical records is a case report on a patient
with post-TURP complaints. Background data and explanations of more
difficult terms are added in brackets. Answers to the questions are on
page 317.
Also presented for your review is an actual surgical pathology report
for a man diagnosed with prostate cancer, as well as a summary of
current knowledge on anabolic steroids.
Case Report: A Man with Post-Turp Complaints
The patient is a 70-year-old man who underwent a TURP for BPH 5 years
ago and now has severe obstructive urinary symptoms with a large
postvoid residual.
On DRE, his prostate was found to be large, bulky, and nodular, with
palpable extension to the left seminal vesicle. His PSA level was 15 ng/mL
[normal is 0 to 4 ng/mL] and a bone scan was negative. A CT scan
revealed bilateral external iliac adenopathy with lymph nodes measuring
1.5 cm on average [normal lymph node size is less than 1 cm]. A prostatic
biopsy revealed a poorly differentiated adenocarcinoma.
This patient most likely has at least stage T3 N+ disease [extension into
seminal vesicles and nodal metastases]. Recommendation is antitestosterone hormonal drug treatment.
Questions about the Case Report
572
1. Five years previously, the patient had which type of surgery?
a. Removal of testicles
b. Perineal prostatectomy
c. Partial prostatectomy (transurethral)
2. What was the reason for the surgery then?
a. Cryptorchidism
b. Benign overgrowth of the prostate gland
c. Testicular cancer
3. What symptom does he have now?
a. Burning pain on urination
b. Urinary retention
c. Premature ejaculation
4. What examination allowed the physician to feel the tumor?
a. Palpation by a finger inserted into the rectum
b. CT scan
c. Prostate-specific antigen test
5. Where had the tumor spread?
a. Testes
b. Pelvic lymph nodes and left seminal vesicle
c. Pelvic bone
6. What is likely to stimulate prostatic adenocarcinoma growth?
a. Hormonal drug treatment
b. Prostatic biopsy
c. Testosterone secretion
7. Stage T3 N+ means that the tumor
a. Is localized to the hip area
b. Is confined to the prostate gland
c. Has spread locally and beyond lymph nodes
8. Why is staging of tumors important?
a. To classify the extent of spread of the tumor and to plan
treatment
b. To make the initial diagnosis
c. To make an adequate biopsy of the tumor
Surgical Pathology Report: Prostate Cancer/Hyperplasia
Patient name: Bill Sco
DOB: 9/14/1942 (Age 78)
Gender: M
Clinical Data: ?Nodule, right side of prostate; PSA 7.1
Specimen(s):
A. Right side prostate biopsy
B. Left side prostate biopsy
FINAL PATHOLOGIC DIAGNOSIS
573
A. Needle biopsy of right side prostate gland (six cores)
ADENOCARCINOMA, MODERATELY TO POORLY
DIFFERENTIATED
Gleason score 4 + 3 = 7
Estimated tumor load, 10% of prostatic tissue
Represented in both specimens A and B
B. Needle biopsy of left side prostate gland
BENIGN HYPERPLASIA
About Anabolic Steroids
Anabolic steroids are male hormones (androgens) that increase body
weight and muscle size and may be used by doctors to increase growth in
boys who do not mature physically as expected for their age. Steroids also
may be used by athletes in an effort to increase strength and enhance
performance; however, significant detrimental side effects of these drugs
have been recognized:
• High levels of anabolic steroids cause acne, hepatic tumors, and
sterility (testicular atrophy and oligospermia).
• In women, the androgenic effect of anabolic steroids leads to male
hair distribution, deepening of the voice, amenorrhea, and clitoral
enlargement.
• Anabolic steroid use also causes hypercholesterolemia, hypertension,
jaundice (liver abnormalities), and salt and water retention (edema).
Gleason Score
The Gleason score (named after Dr. Donald Gleason, a pathologist who
developed it in the 1960s) is based on the microscopic appearance of the
prostate biopsy specimen. Cancers with a higher Gleason score are more
aggressive and carry a worse prognosis. The pathologist assigns a grade
(number) to the most common tumor cells and another to the next most
common tumor cells. Adding these numbers together gives the Gleason
score. The score is based on a scale from 1 to 5. More well-differentiated
(closer to normal) cells are given a lower grade, and poorly differentiated
(malignant) cells are given a higher grade.
In Person
Prostate Cancer
574
This is a first-person narrative of a man diagnosed with prostate cancer.
As with many men in their late 50s, the PSA prostate-related lab test
was the first item I would always look at when having my annual
physical. Over a few years, the PSA had been going up gradually, but
nothing that seemed to indicate anything unusual. So it was a bit of a
surprise when my primary care doctor suggested that it might be time to
have a further medical review of the slowly increasing results. The PSA
was 4.37 ng/mL (4.0 or less is considered normal).
Being in good overall health, I expected the follow-up prostate exam
and biopsy to be of a routine nature. It was with great surprise that the
prostate biopsy showed that 3 of 12 samples were positive for cancerous
cells. My Gleason score was 6 (3 + 3). This situation was described to me
as favorable, an early-stage cancer. Nevertheless, I had no idea of the
treatment options available.
I decided that the best way to reach a decision for a treatment plan was
to get together with the doctors at the Mass General Cancer Center
genitourinary clinic, where my situation would be reviewed, and to learn
more about my options. I realized that the possibilities ranged widely,
including watchful waiting, external radiation, internal radiation, and
prostate surgery (prostatectomy). In the end, the decision becomes your
own in early-stage prostate cancer, and that, in itself, can leave you
second-guessing the choice.
After careful thought and review of the information with my physicians
and family, I decided to pursue the internal radiation option, or
brachytherapy, often referred to as implantation of radiation seeds. Even
up to the time of the procedure, the question remained with me as to
whether I was making the right choice. Should I wait a while and just see
how things go? Would there be any of the side effects that are noted for
this procedure, such as bowel or bladder irritation? I had the internal
radiation done at MGH. The entire medical team there made the process
from start to completion as easy an event as one could hope for. The best
news was that after the procedure, as tumor disappeared, my PSA began
to drop.
575
Now a year has passed, and I am happy to see that the PSA has
continued downward. The long-term side effects of the brachytherapy
procedure were related to urination and erectile dysfunction. While
urination post-procedure was painful, discomfort dissipated within a
week or so. Long term, managing the control of urination was an issue,
but after a year it has definitely improved. Erectile dysfunction after any
type of prostate procedure is an issue. I found it to be a major effect early
on, but less as time progressed. There is still the required PSA testing to
see that the tumor has not returned. But taking warning signs seriously,
educating yourself, and making an informed decision with the help of the
best medical team possible will make you feel good about your choices.
Kevin Mahoney is a U.S. veteran, now working as a program manager. He
enjoys spending time with his family, including his wife, children, and
grandchildren.
576
Exercises
Remember to check your answers carefully with those given in the
Answers to Exercises, page 316.
A Using the terms below, fill in the flow chart showing
the passage of sperm.
epididymis
ejaculatory duct
penis
seminiferous tubules
urethra
vas deferens
B Select from the list of terms to match the descriptions
that follow.
bulbourethral glands
epididymis
prepuce
577
prostate gland
scrotum
seminal vesicles
seminiferous tubules
spermatozoon
testis
vas deferens
1. one of a pair of long, tightly coiled tubes above each
testis; carries and stores sperm ________
2. exocrine gland at the base of the male urinary
bladder _______________________
3. narrow coiled tubules that produce sperm in the
testes ______________________________
4. sperm cell
_______________________________________________
__________________
5. foreskin
_______________________________________________
__________________________
6. male gonad; produces testosterone and sperm cells
_____________________________________
7. paired sac-like exocrine glands that secrete fluid into
the vas deferens _____________________
8. external sac that contains the testes
_______________________________________________
___
9. narrow tube carrying sperm from the epididymis
toward the urethra ______________________
10. pair of exocrine glands near the male urethra;
Cowper glands _______________________
578
C Select from the list of terms to match the descriptions
that follow.
ejaculation
ejaculatory duct
erectile dysfunction
flagellum
fraternal twins
glans penis
identical twins
interstitial cells
parenchymal tissue
perineum
1. hair-like projection on a sperm cell that makes it
motile _________________________________
2. sensitive tip of the penis
_______________________________________________
____________
3. tube through which semen enters the urethra
_________________________________________
4. two infants resulting from division of one fertilized
egg into separate embryos ______________
5. external region between the anus and scrotum
_________________________________________
6. essential distinctive cells of an organ
_______________________________________________
__
7. two infants resulting from fertilization of two ova by
two sperm cells ______________________
8. inability of an adult male to achieve erection;
impotence ________________________________
579
9. specialized cells that lie adjacent to the seminiferous
tubules _____________________________
10. ejection of sperm and fluid from the urethra
__________________________________________
D Match the listed terms with the descriptions that
follow.
aspermia
azoospermia
impotence
oligospermia
penis
semen
sterilization
stromal tissue
testicle
testosterone
1. male external organ of reproduction
___________________________________________
2. sperm cells and seminal fluid
_______________________________________________
__
3. hormone secreted by interstitial cells of the testes
_________________________________
4. supportive connective tissue of an organ
________________________________________
5. lack of semen
_______________________________________________
______________
6. lack of sperm cells in semen
_______________________________________________
580
___
7. procedure that removes a person's ability to produce
or release reproductive cells ________
8. semen with a low concentration of sperm
_______________________________________
9. male gonad
_______________________________________________
________________
10. inability of a male to sustain or achieve an erection
_______________________________
E Build medical terms for the following definitions.
Parts of the words are given.
1. inflammation of the testes:
__________________________itis
2. inflammation of the tube that carries the
spermatozoa to the vas deferens:
______________________________itis
3. resection of the prostate gland:
__________________________ectomy
4. inflammation of the prostate gland:
__________________________itis
5. process of producing (the formation of) sperm cells:
______________________genesis
6. fixation of undescended testicle:
orchio___________________________
7. inflammation of the glans penis:
__________________________itis
8. condition of scanty sperm:
__________________________spermia
9. lack of semen: a___________________________
581
10. pertaining to a testicle:
__________________________ar
F Answer true or false:
1. ___________ Cryogenic surgery uses cold
temperatures to destroy tissue.
2. ___________ Estrogen is an example of an androgen.
3. ___________ Castration (orchiectomy or
oophorectomy) is an example of sterilization.
4. ___________ A teratoma is a benign tumor of the
prostate gland.
5. ___________ Spermolytic means formation of sperm.
6. ___________ Balanitis is inflammation of a testicle.
7. ___________ Azoospermia causes infertility.
8. ___________ Aspermia can result from retrograde
ejaculation.
9. ___________ Seminiferous tubules are the interstitial
cells of the testes.
10. ___________ Testosterone is produced by the
parenchymal tissue of the testes.
11. ___________ Vasectomy produces impotence.
12. ___________ Vasovasostomy is an anastomosis that
can restore fertility (ability to reproduce offspring).
G Match the term in Column I with its meaning in
Column II. Write the correct le er in the space
provided.
582
COLUMN I
1. castration
2. semen analysis
3. ejaculation
4. purulent
5. vasectomy
6. circumcision
7. ligation
8. cryosurgery
9. seminoma
10. phimosis
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
COLUMN II
A. To tie off or bind
B. Removal of a piece of the vas deferens
C. Orchiectomy
D. Removal of the prepuce
E. Destruction of tissue by freezing
F. Pus-filled
G. Test of fertility (reproductive ability)
H. Ejection of sperm and fluid from the urethra
I. Narrowing (stricture) of the opening of the prepuce over the glans penis
J. Malignant tumor of the testis
H Select from the listed terms to fit the descriptions that
follow.
adenocarcinoma of the prostate
benign prostatic hyperplasia
cryptorchidism
gonorrhea
herpes genitalis
HPV infection
hydrocele
hypospadias
syphilis
varicocele
1. prostatic enlargement, nonmalignant
_______________________________________________
_
2. opening of the urethra on the undersurface of the
penis _________________________________
3. infection of skin and genital mucosa with HSV
_________________________________________
4. malignant tumor of the prostate gland
_______________________________________________
5. enlarged, swollen veins near the testes
_______________________________________________
583
6. sexually transmi ed disease with primary stage
marked by formation of a chancre ___________
7. infection of the skin and mucous membranes in the
anogenital region by human papillomavirus
__________________________________________
8. STI caused by berry-shaped bacteria and marked by
inflammation of genital mucosa and mucopurulent
discharge ____________________________
9. undescended testicles
_______________________________________________
_____________
10. sac of clear fluid in the scrotum
_______________________________________________
______
I Spell out the abbreviations in Column I. Then match
each abbreviation with its correct meaning from
Column II.
584
COLUMN I
_______
1. PSA
______________________________________________________________________
_______
2. BPH
______________________________________________________________________
_______
3. TURP
______________________________________________________________________
_______
4. TRUS
______________________________________________________________________
_______
5. DRE
______________________________________________________________________
_______
6. HSV
______________________________________________________________________
_______
7. STI
______________________________________________________________________
_______
8. RALP
______________________________________________________________________
COLUMN II
A. Manual
diagnostic
procedure to
examine the
prostate gland
B. Removal of
portions of
prostate gland
through the
urethra
C. Etiologic
agent of a
sexually
transmi ed
disease
characterized
by blister
formation
D.
Noncancerous
enlargement
of the prostate
gland
E. Chlamydia,
gonorrhea,
and syphilis
are examples
of this general
category of
infections
F. Helpful
procedure in
guiding a
prostatic
biopsy needle
G. High serum
levels of this
protein
indicate
prostatic
carcinoma
H. Assisted
laparoscopic
surgery to
remove the
prostate gland
J Give the meanings of the following word parts.
1. -one _____________________________
2. -stomy ___________________________
3. semin/i ___________________________
4. -cele _____________________________
5. -pexy _____________________________
6. -genesis __________________________
585
7. -plasia ____________________________
8. prostat/o __________________________
9. orch/o ____________________________
10. terat/o ____________________________
11. gon/o ____________________________
12. hydr/o ____________________________
13. pen/o _____________________________
14. balan/o ___________________________
15. varic/o ____________________________
16. vas/o _____________________________
17. test/o _____________________________
18. zo/o ______________________________
19. crypt/o ___________________________
20. andr/o ____________________________
K Match the listed surgical procedures with the
following reasons for performing them.
circumcision
hydrocelectomy
orchiectomy
orchiopexy
photoselective vaporization of the prostate
radical (complete) prostatectomy
varicocelectomy
vasectomy
vasovasostomy
1. prostate cancer _________________________
2. cryptorchidism _________________________
586
3. sterilization (hormones remain and potency is not
impaired) ______________________________
4. benign prostatic hyperplasia
_________________________
5. abnormal collection of fluid in a scrotal sac
_________________________
6. reversal of sterilization procedure
_________________________
7. embryonal carcinoma of the testes
_________________________
8. phimosis _________________________
9. ligation of swollen, twisted veins above the testes
_________________________
L Use the given definitions to complete the terms. Check
your answers carefully.
1. gland at the base of the urinary bladder in males: pro
_________________________ gland
2. coiled tube on top of each testis: epi
_________________________
3. essential tissue of an organ: par
_________________________ tissue
4. foreskin: pre _________________________
5. bacterial infection that invades the urethra and
reproductive tract of men and women and is the
major cause of nonspecific urethritis in males and
cervicitis in females: ch _________________________
6. ulcer that forms on genital organs after infection with
syphilis: ch ________________________
7. androgen produced by the interstitial cells of the
testis: test _________________________
587
8. fluid secreted by male reproductive glands and
ejaculated with sperm: se ___________________
9. malignant tumor of the testis: sem
_________________________
10. pertaining to the penis: pen
_________________________
M Circle the correct term(s) to complete the following
sentences.
1. When Fred was a newborn infant, his doctors could
feel only one testicle within the scrotum and
suggested close monitoring of his condition of
(gonorrhea, cryptorchidism, benign prostatic
hyperplasia).
2. Bob had many sexual partners, one of whom had
been diagnosed with (testosterone, phimosis,
chlamydia), a highly communicable STI.
3. At age 65, Mike had some difficulty with urgency
and discomfort when urinating. His doctor did a
digital rectal examination to examine his (prostate
gland, urinary bladder, vas deferens).
4. Just after Nick's birth, his parents had a difficult time
deciding whether to have their infant son undergo
(TURP, castration, circumcision).
5. Ted noticed a hard ulcer on his penis and made an
appointment with his doctor, a (gastroenterologist,
gynecologist, urologist). The doctor viewed a
specimen of the ulcer under the microscope and did
a blood test, which revealed that Ted had contracted
(gonorrhea, herpes genitalis, syphilis), so the ulcer
was a (blister, chancre, seminoma).
6. After his fifth child was born, Art decided to have a
(vasovasostomy, hydrocelectomy, vasectomy) to
588
prevent conception of another child. A/an
(nephrologist, urologist, abdominal surgeon)
performed the procedure to cut and ligate the
(urethra, epididymis, vas deferens).
7. Twenty-six-year-old Lance noticed a hard testicular
mass. His physician prescribed a brief trial with
(antibodies, antibiotics, pain killers) to rule out
(epididymitis, testicular cancer, varicocele). The
mass remained and Lance underwent
(epididymectomy, orchiectomy, prostatectomy). The
mass was a (seminoma, prostate cancer, hydrocele).
8. Sarah and Steve had been trying to conceive a child
for 7 years. Steve had a (digital rectal examination,
TURP, semen analysis), which revealed 25% normal
sperm count with 10% motility. He was told he had
(phimosis, azoospermia, oligospermia).
9. To boost his sperm count, Steve was given (estrogen,
testosterone, progesterone). As a side effect, this
(androgen, progestin, enzyme) gave him a case of
acne lasting several months.
10. Sarah eventually became pregnant. An ultrasound
examination showed two embryos with two separate
placentas and in separate (peritoneal, scrotal,
amniotic) sacs. Sarah gave birth to two healthy
(identical, fraternal, perineal) twin girls.
589
Answers to Exercises
A
1. seminiferous tubules
2. epididymis
3. vas deferens
4. ejaculatory duct
5. urethra
6. penis
B
1. epididymis
2. prostate gland
3. seminiferous tubules
4. spermatozoon
5. prepuce
6. testis
7. seminal vesicles
8. scrotum
9. vas deferens
10. bulbourethral (Cowper) glands
C
1. flagellum
2. glans penis
3. ejaculatory duct
590
4. identical twins
5. perineum
6. parenchymal tissue
7. fraternal twins
8. erectile dysfunction
9. interstitial cells
10. ejaculation
D
1. penis
2. semen
3. testosterone
4. stromal tissue
5. aspermia
6. azoospermia
7. sterilization
8. oligospermia
9. testicle
10. impotence
E
1. orchitis
2. epididymitis
3. prostatectomy
4. prostatitis
5. spermatogenesis
591
p
g
6. orchiopexy
7. balanitis
8. oligospermia
9. aspermia
10. testicular
F
1. True.
2. False. Estrogen is a female hormone. Androgens are
male hormones. Testosterone is an androgen.
3. True.
4. False. Teratoma is a malignant tumor in the testis.
5. False. Spermolytic is destruction of sperm.
Spermatogenesis is formation of sperm.
6. False. Balanitis is inflammation of the glans penis.
Orchitis is inflammation of a testicle.
7. True.
8. True. Semen is discharged backward into the urinary
bladder and not ejaculated.
9. False. Seminiferous tubules are the parenchymal tissue
of the testes. The interstitial cells of the testis are the
Leydig cells that secrete testosterone.
10. False. Testosterone is produced by the interstitial cells
of the testis.
11. False. Vasectomy results in the inability of sperm to
leave the body in semen. It does not affect erectile
dysfunction and does not produce impotence.
12. True.
592
G
1. C
2. G
3. H
4. F
5. B
6. D
7. A
8. E
9. J
10. I
H
1. benign prostatic hyperplasia
2. hypospadias
3. herpes genitalis
4. adenocarcinoma of the prostate (prostate cancer)
5. varicocele
6. syphilis
7. HPV infection
8. gonorrhea
9. cryptorchidism
10. hydrocele
I
1. prostate-specific antigen: G
593
p
p
g
2. benign prostatic hyperplasia: D
3. transurethral resection of the prostate: B
4. transrectal ultrasound: F
5. digital rectal examination: A
6. herpes simplex virus: C
7. sexually transmi ed infection: E
8. robotic assisted laparoscopic prostatectomy: H
J
1. hormone
2. opening
3. semen, seed
4. hernia, swelling
5. fixation
6. formation
7. formation
8. prostate gland
9. testis
10. monster
11. seed
12. water
13. penis
14. glans penis
15. varicose veins
16. vessel, duct, vas deferens
594
17. testis, testicle
18. animal life
19. hidden
20. male
K
1. radical (complete) prostatectomy
2. orchiopexy
3. vasectomy
4. photoselective vaporization of the prostate
5. hydrocelectomy
6. vasovasostomy
7. orchiectomy
8. circumcision
9. varicocelectomy
L
1. prostate
2. epididymis
3. parenchymal
4. prepuce
5. chlamydia
6. chancre
7. testosterone
8. semen or seminal fluid
9. seminoma
595
10. penile
M
1. cryptorchidism
2. chlamydia
3. prostate gland
4. circumcision
5. urologist; syphilis; chancre
6. vasectomy; urologist; vas deferens
7. antibiotics; epididymitis; orchiectomy; seminoma
8. semen analysis; oligospermia
9. testosterone; androgen
10. amniotic; fraternal
Answers to Practical Applications
Case Report: A Man with Post-TURP Complaints
1. c
2. b
3. b
4. a
5. b
6. c
7. c
8. a
596
Pronunciation of Terms
The terms you have learned in this chapter are presented here with their
pronunciations. The meanings for all the terms are in the Mini-Dictionary
beginning on page 897. You can also hear each term pronounced on the
Evolve website (h p://evolve.elsevier.com/Chabner/language/).
597
TERM
androgen
aspermia
azoospermia
balanitis
benign prostatic hyperplasia
bulbourethral glands
castration
chancre
chlamydia
circumcision
cryogenic surgery
cryptorchidism
digital rectal exam
ejaculation
ejaculatory duct
embryonal carcinoma
epididymis
epididymitis
erectile dysfunction
flagellum
fraternal twins
glans penis
gonorrhea
herpes genitalis
human papillomavirus
hydrocele
hypospadias
identical twins
impotence
infertility
interstitial cells of the testes
ligation
oligospermia
orchiectomy
orchiopexy
orchitis
parenchymal tissue
penile
penis
penoscrotal
perineum
Peyronie disease
phimosis
photoselective vaporization of the
prostate
prepuce
prostate cancer
prostate gland
prostatectomy
prostatitis
purulent
scrotum
semen
PRONUNCIATION
AN-dro-jen
a-SPER-me-ah
a-zo-o-SPER-me-ah
bal-ah-NI-tis
be-NINE pros-TAH-tik hi-per-PLA-ze-ah
bul-bo-u-RE-thral glandz
kah-STRA-shun
SHANK-er
klah-MID-e-ah
sir-kum-SIZH-un
kri-o-GEN-ik SUR-jer-e
kript-OR-kid-izm
DIH-jeh-tal REK-tal ek-ZAM
eh-jak-u-LA-shun
eh-JAK-u-lah-tor-e dukt
em-bre-ON-al kar-sih-NO-mah
ep-ih-did-ih-mis
ep-ih-did-ih-MI-tis
e-REK-tile dis-FUNK-shun
fla-JEL-um
frah-TER-nal twinz
glanz PE-nis
gon-o-RE-ah
HER-peez jen-ih-TAL-is
HU-man pap-ih-LO-mah-vi-rus
HI-dro-seel
hi-po-SPA-de-as
i-DEN-tih-kal twinz
IM-po-tents
in-fer-TIL-ih-te
in-ter-STIH-shul selz of the TES-tis
li-GA-shun
ol-ih-go-SPER-me-ah
or-ke-EK-to-me
or-ke-o-PEK-se
or-KI-tis
pah-RENK-ih-mal TIH-shu
PE-nile
PE-nis
pe-no-SKRO-tal
peh-rih-NE-um
pah-RO-ne dih-zeez
fih-MO-sis
fo-to-seh-LEK-tiv va-por-ih-ZA-shun of the PROStayt
PRE-pus
PROS-tayt KAN-ser
PROS-tayt gland
pros-tah-TEK-to-me
pros-tah-TI-tis
PU-ru-lent
SKRO-tum
SE-men
598
TERM
semen analysis
seminal vesicles
seminiferous tubules
seminoma
spermatogenesis
spermatozoa
spermatozoon
spermolytic
sterilization
stromal tissue
syphilis
teratoma
testicular
testicular cancer
testicular torsion
testis
testosterone
transurethral resection of the prostate
varicocele
vas deferens
vasectomy
vasovasostomy
PRONUNCIATION
SE-men ah-NAH-lih-sis
SEH-mih-nal VES-ih-kils
seh-mih-NIF-er-us TOOB-ules
seh-mih-NO-mah
sper-mah-to-JEN-eh-sis
sper-mah-to-ZO-ah
sper-mah-to-ZO-en
sper-mo-LIH-rik
ster-ih-lih-ZA-shun
STRO-mal TIH-shu
SIF-ih-lis
ter-ah-TO-mah
tes-TIH-ku-lar
tes-TIH-ku-lar KAN-ser
tes-TIH-ku-lar TOR-shun
TES-tis
tes-TOS-teh-rone
tranz-u-RE-thral re-SEK-shun of the PROS-tayt
VAR-ih-ko-seel
vas DEF-er-enz
vas-EK-to-me
vas-o-vas-OS-to-me
Review Sheet
Write the meanings of the word parts in the spaces provided. Check your
answers with the information in the chapter or in the Glossary (Medical
Word Parts—English) at the end of the book.
Combining Forms
599
COMBINING FORM
andr/o
balan/o
cry/o
crypt/o
epididym/o
gon/o
hydr/o
orch/o
orchi/o
orchid/o
pen/o
prostat/o
semin/i
sperm/o
spermat/o
terat/o
test/o
varic/o
vas/o
zo/o
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Suffixes
SUFFIX
-cele
-ectomy
-gen
-genesis
-genic
-lysis
-lytic
-one
-pexy
-plasia
-rrhea
-stomy
-tomy
-trophy
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
600
CHAPTER 10
601
Nervous System
CHAPTER SECTIONS:
Introduction 322
General Structure of the Nervous System 322
Neurons, Nerves, and Glial Cells 326
The Brain 328
The Spinal Cord and Meninges 331
Vocabulary 333
Terminology 335
Pathology 340
Laboratory Tests and Clinical Procedures 349
Abbreviations 352
Practical Applications 352
In Person: Sciatica 356
Exercises 357
Answers to Exercises 364
Pronunciation of Terms 367
Review Sheet 370
CHAPTER GOALS
• Name, locate, and describe the major organs of the nervous system and
their functions.
• Learn nervous system combining forms and use them with suffixes and
prefixes.
• Define pathologic conditions affecting the nervous system.
602
• Describe nervous system–related laboratory tests, clinical procedures,
and abbreviations.
• Apply your new knowledge to understanding medical terms in their proper
contexts, such as medical reports and records.
603
Introduction
The nervous system is one of the most complex of all human body
systems. More than 100 billion nerve cells operate constantly all over the
body to coordinate the activities we do consciously and voluntarily, as
well as those that occur unconsciously or involuntarily. We speak, move
muscles, hear, taste, see, and think. Our glands secrete hormones, and
we respond to danger, pain, temperature, and touch. All of these
functions comprise only a small number of the many activities
controlled by the nervous system.
Fibers exiting from microscopic nerve cells (neurons) are collected
into macroscopic bundles called nerves, which carry electrical messages
all over the body. External stimuli, as well as internal chemicals such as
acetylcholine, activate the cell membranes of nerve cells, which results
in electrical discharges of these cells. These electrical discharges,
nervous impulses, may then traverse the length of the associated
nerves. External receptors (sense organs) as well as internal receptors in
muscles and blood vessels receive these impulses and may in turn
transmit impulses to the complex network of nerve cells in the brain
and spinal cord. Within this central part of the nervous system,
impulses are recognized, interpreted, and finally relayed to other nerve
cells that extend out to all parts of the body, such as muscles, glands,
and internal organs.
604
General Structure of the Nervous
System
The nervous system is classified into two major divisions: the central
nervous system (CNS) and the peripheral nervous system (PNS). The
central nervous system consists of the brain and spinal cord. The
peripheral nervous system consists of cranial nerves and spinal nerves,
plexuses, and peripheral nerves throughout the body (Figure 10-1).
Cranial nerves carry impulses between the brain and the head and neck.
The one exception is the tenth cranial nerve, called the vagus nerve. It
carries messages to and from the neck, chest, and abdomen. Figure 10-2
shows cranial nerves, their functions, and the parts of the body that they
carry messages to and from. Spinal nerves carry messages between the
spinal cord and the chest, abdomen, and extremities.
605
FIGURE 10-1 The brain and the spinal cord, spinal nerves,
and spinal plexuses. The femoral nerve is a lumbar nerve
leading to and from the thigh region (the femur is the thigh bone).
The sciatic nerve is a nerve beginning in a region of the hip. The
cauda equina (Latin for “horse's tail”) is a bundle of spinal
nerves below the end of the spinal cord.
606
FIGURE 10-2 Cranial nerves (I to XII) leading from the base of
the brain and showing the parts of the body they affect. Sensory
or afferent nerves are colored blue and carry messages toward
the brain. Motor or efferent nerves are colored red and carry
messages from the brain to muscles and organs. Some nerves
(mixed) carry both sensory and motor fibers. Don't try to
memorize this figure! Just get the big picture: Cranial nerves
carry messages to and from the brain to all parts of head and
neck and also (in the case of the vagus nerve) to other parts of
the body.
A plexus is a large network of nerves in the peripheral nervous
system. The cervical, brachial (brachi/o means arm), and lumbosacral
plexuses are examples that include cervical, lumbar, and sacral nerves.
607
Figure 10-1 illustrates the relationship of the brain and spinal cord to the
spinal nerves and plexuses.
Plexus
There are other plexuses in the body—networks of intersecting blood
vessels (vascular) and lymphatic vessels.
• Lymphatic plexus is an interconnecting network of lymph vessels.
• Rectal plexus is a plexus of veins in the rectal region.
• Vertebral plexus is a plexus of veins related to the backbone.
The spinal and cranial nerves are composed of nerves that help the
body respond to changes in the outside world. They include sense
receptors for sight (eye), hearing and balance (ear), smell (olfactory),
and touch (skin sensation) and sensory (afferent) nerves that carry
messages related to changes in the environment toward the spinal cord
and brain. In addition, motor (efferent) nerves travel from the spinal
cord and brain to muscles of the body, telling them how to respond. For
example, when you touch a hot stove, temperature and pain receptors
in the skin stimulate afferent nerves, which carry messages toward the
spinal cord and brain. Instantaneously, the message is conveyed to
efferent nerve cells in the spinal cord, which then activate voluntary
muscles to pull your hand away from the stove.
In addition to the spinal and cranial nerves (whose functions are
mainly voluntary and involved with sensations of smell, taste, sight,
hearing, and muscle movements), the peripheral nervous system also
contains a large group of nerves that function involuntarily or
automatically, without conscious control. These peripheral nerves
belong to the autonomic nervous system. This system of nerve fibers
carries impulses to glands, heart, blood vessels, involuntary muscles
found in the walls of tubes like the intestines, and hollow organs like
the stomach and urinary bladder.
Some autonomic nerves are sympathetic nerves and others are
parasympathetic nerves. The sympathetic nerves stimulate the body in
times of stress and crisis. They increase heart rate and forcefulness,
dilate (relax) airways so more oxygen can enter, and increase blood
pressure. In addition, sympathetic neurons stimulate the adrenal glands
to secrete epinephrine (adrenaline), while also inhibiting intestinal
contractions to slow digestion. The parasympathetic nerves normally
act as a balance for the sympathetic nerves. Parasympathetic nerves
slow down heart rate, lower blood pressure, and stimulate intestinal
608
contractions to clear the rectum. Figure 10-3 shows the differences in
actions between the sympathetic and parasympathetic nerves.
FIGURE 10-3 Actions of parasympathetic and sympathetic
nerves.
Figure 10-4 summarizes the divisions of the central and peripheral
nervous systems.
609
FIGURE 10-4 Divisions of the central nervous system (CNS)
and peripheral nervous system (PNS). The autonomic nervous
system is a part of the peripheral nervous system.
610
Neurons, Nerves, and Glial Cells
A neuron is an individual nerve cell, a microscopic structure. Impulses
pass along the parts of a nerve cell in a definite manner and direction.
The parts of a neuron are pictured in Figure 10-5; label it as you study
the following.
FIGURE 10-5 Parts of a neuron and the pathway of a
nervous impulse. Neurons are the parenchymal (essential)
cells of the nervous system. The boxed drawing shows what
happens in a synapse: Vesicles store neurotransmitters in the
terminal end fibers of axons. Receptors on the dendrites pick up
the neurotransmitters. Inactivators end the activity of
neurotransmitters when they have finished their job.
A stimulus begins an impulse in the branching fibers of the neuron,
which are called dendrites [1]. A change in the electrical charge of the
611
dendrite membranes is thus begun, and the nervous impulse moves
along the dendrites like the movement of falling dominoes. The
impulse, traveling in only one direction, next reaches the cell body [2],
which contains the cell nucleus [3]. Small collections of nerve cell
bodies outside the brain and spinal cord are called ganglia (singular:
ganglion). Extending from the cell body is the axon [4], which carries
the impulse away from the cell body. Axons can be covered with a fa y
tissue called myelin. The purpose of this myelin sheath [5] is to insulate
the axon and speed transmission of the electrical impulse.
Demyelination is loss of the myelin insulating the nerve fiber and is
characteristic of multiple sclerosis, an acquired illness affecting the CNS.
The myelin sheath gives a white appearance to the nerve fiber—hence
the term white ma er, as in parts of the spinal cord and the white
ma er of the brain and most peripheral nerves. The gray ma er of the
brain and spinal cord is composed of the cell bodies of neurons that
appear gray because they are not covered by a myelin sheath.
The nervous impulse passes through the axon to leave the cell via the
terminal end fibers [6] of the neuron. The space where the nervous
impulse jumps from one neuron to another is called the synapse [7].
The transfer of the impulse across the synapse depends on the release of
a chemical substance, called a neurotransmi er, by the neuron that
brings the impulse to the synapse. See the boxed diagram in Figure 10-5.
Tiny sacs (vesicles) containing the neurotransmi er are located at the
ends of neurons, and they release the neurotransmi er into the synapse.
Acetylcholine, norepinephrine, epinephrine (adrenaline), dopamine,
serotonin, and endorphins are examples of neurotransmi ers.
Whereas a neuron is a microscopic structure within the nervous
system, a nerve is macroscopic, able to be seen with the naked eye. A
nerve consists of many axons that travel together like strands of rope.
Peripheral nerves that carry impulses to the brain and spinal cord from
stimulus receptors like the skin, eye, ear, and nose are afferent or
sensory nerves; those that carry impulses from the CNS to organs that
produce responses, such as muscles and glands, are efferent or motor
nerves.
Neurons and nerves are the parenchyma of the nervous system.
Parenchyma is the essential distinguishing tissue of an organ. In the
brain and spinal cord, neurons, which conduct electrical impulses, are
the parenchymal tissue. Stroma of an organ is the connective and
supportive tissue of an organ. The stromal tissue of the central nervous
system consists of the glial (neuroglial) cells, which make up its
supportive framework and help it ward off infection. Glial cells do not
transmit impulses. They are far more numerous than neurons and can
reproduce.
612
There are four types of supporting or glial cells (see Figure 10-6).
Astrocytes (astroglial cells) are star-like in appearance (astr/o means
star) and transport water and salts between capillaries and neurons.
Microglial cells are small cells with many branching processes
(dendrites). As phagocytes, they protect neurons in response to
inflammation. Oligodendroglial cells (oligodendrocytes) have few
(olig/o means few or scanty) dendrites. These cells form the myelin
sheath in the CNS. By contrast, ependymal cells (Greek ependyma
means upper garment) line membranes within the brain and spinal cord
where CSF is produced and circulates.
FIGURE 10-6 Glial cells (neuroglial cells). These are the
supportive, protective, and connective tissue cells of the CNS.
Glial cells are stromal (framework) tissue, whereas neurons
carry nervous impulses.
Glial cells, particularly the astrocytes, are associated with blood
vessels and regulate the passage of potentially harmful substances from
the blood into the nerve cells of the brain. This protective barrier
between the blood and brain cells is called the blood-brain barrier
(BBB). This barrier consists of special lining (endothelial) cells, which
along with astrocytes separate capillaries from nerve cells. Delivery of
chemotherapeutic drugs to treat brain tumors is thus difficult, because
the BBB blocks drug access to brain tissues. Figure 10-6 illustrates glial
cells.
613
The Brain
The brain controls body activities. In the human adult, it weighs about 3
pounds and has many different parts, all of which control different
aspects of body functions.
The largest part of the brain is the “thinking” area, or cerebrum. On
the surface of the cerebrum, nerve cells lie in sheets, which make up the
cerebral cortex. These sheets, arranged in folds called gyri, are
separated from each other by grooves known as sulci. The brain is
divided in half, a right side and a left side, which are called cerebral
hemispheres. Each hemisphere is subdivided into four major lobes
named for the cranial (skull) bones that overlie them. Figure 10-7 shows
these lobes—frontal, parietal, occipital, and temporal—as well as gyri
and sulci.
FIGURE 10-7 Left cerebral hemisphere (lateral view). Gyri
(convolutions) and sulci (fissures) are indicated. Notice the lobes
of the cerebrum and the functional centers that control speech,
vision, movement, hearing, thinking, and other processes.
Neurologists believe that the two hemispheres have different
abilities. The left brain is more concerned with language,
mathematical functioning, reasoning, and analytical thinking. The
right brain is more active in spatial relationships, art, music,
emotions, and intuition.
614
The cerebrum has many functions. It is responsible for thought,
judgment, memory, association, and discrimination. In addition,
sensory impulses are received through afferent cranial nerves, and
when registered in the cortex, they are the basis for perception. Nerve
impulses from the cerebrum extend to muscles and glands producing
movement as well as internal changes in the body. Figure 10-7 shows
the location of some of the centers in the cerebral cortex that control
speech, vision, smell, movement, hearing, and thought processes.
In the middle of the cerebrum are spaces, or canals, called ventricles
(pictured in Figure 10-8). They contain a watery fluid that flows
throughout the brain and around the spinal cord. This fluid is
cerebrospinal fluid (CSF), and it protects the brain and spinal cord
from shock by acting like a cushion. CSF usually is clear and colorless
and contains lymphocytes, sugar, and proteins. Spinal fluid can be
withdrawn for diagnosis or relief of pressure on the brain; this is called
a lumbar puncture (LP). For this procedure, a hollow needle is inserted
into the lumbar region of the spinal column below the region where the
nervous tissue of the spinal cord ends, and CSF is withdrawn.
FIGURE 10-8 Circulation of cerebrospinal fluid (CSF) in the
brain (ventricles) and around the spinal cord. CSF is formed
within the ventricles and circulates between the membranes
around the brain and within the spinal cord. CSF empties into the
bloodstream through the membranes surrounding the brain and
spinal cord.
615
Two other important parts of the brain are the thalamus and the
hypothalamus (Figure 10-9). The thalamus acts like a triage center. It
decides what is important and what is not, selectively processing and
relaying sensory information to the cerebral cortex. The thalamus also
plays a major role in maintaining levels of awareness and
consciousness. The hypothalamus (below the thalamus) contains
neurons that control body temperature, sleep, appetite, sexual desire,
and emotions such as fear and pleasure. The hypothalamus also
regulates the release of hormones from the pituitary gland at the base of
the brain and integrates the activities of the sympathetic and
parasympathetic nervous systems.
FIGURE 10-9 Parts of the brain: cerebrum, thalamus,
hypothalamus, cerebellum, midbrain, pons, and medulla
oblongata. Note the location of the pituitary gland below the
hypothalamus. The basal ganglia (a group of cells) regulate
intentional movements of the body. The corpus callosum lies in
the center of the brain and connects the two hemispheres
(halves).
The following structures within the brain lie in the back and below
the cerebrum and connect the cerebrum with the spinal cord:
cerebellum, midbrain, pons, and medulla oblongata. The midbrain,
pons and medulla are part of the brainstem. See Figure 10-9.
The cerebellum functions to coordinate voluntary movements and to
maintain balance and posture.
616
The midbrain is the uppermost portion of the brainstem. It contains
pathways connecting the cerebrum with lower portions of the brain and
structures involved with seeing and hearing.
The pons is a part of the brainstem that literally means bridge. It
contains nerve fiber tracts that connect the cerebellum and cerebrum
with the rest of the brain. Nerves affecting the face and eye movement
are located here.
The medulla oblongata, also in the brainstem, connects the spinal
cord with the rest of the brain. Nerve tracts cross from right to left and
left to right in the medulla oblongata. For example, nerve cells that
control movement of the left side of the body are found in the right half
of the cerebrum. These cells send out axons that cross over (decussate)
to the opposite side of the brain in the medulla oblongata and then
travel down the spinal cord.
In addition, the medulla oblongata contains three important vital
centers that regulate internal activities of the body:
1. Respiratory center—controls muscles of respiration in response
to chemicals or other stimuli
2. Cardiac center—slows the heart rate when the heart is beating
too rapidly
3. Vasomotor center—affects (constricts or dilates) the muscles in
the walls of blood vessels, thus influencing blood pressure
Figure 10-9 shows the locations of the thalamus, hypothalamus,
cerebellum, pons, and medulla oblongata. Table 10-1 reviews the
functions of these parts of the brain.
TABLE 10-1
FUNCTIONS OF THE PARTS OF THE BRAIN
Structure
Cerebrum
Thalamus
Function(s)
Thinking, personality, sensations, movements, memory
Relay station (“triage center”) for sensory impulses; control of awareness
and consciousness
Hypothalamus Body temperature, sleep, appetite, emotions; control of the pituitary
gland
Cerebellum
Coordination of voluntary movements and balance
Pons and
Connection of nerve and nerve fiber pathways, including those to the
Midbrain
eyes and face
Medulla
Nerve fibers cross over, left to right and right to left; contains centers to
oblongata
regulate heart, blood vessels, and respiratory system
617
The Spinal Cord and Meninges
Spinal Cord
The spinal cord is a column of nervous tissue extending from the
medulla oblongata to the second lumbar vertebra within the vertebral
column. Below the end of the spinal cord is the cauda equina (Latin for
“horse's tail”), a fan of nerve fibers (see Figure 10-1, page 323). The
spinal cord carries all the nerves to and from the limbs and lower part of
the body, and it is the pathway for impulses going to and from the
brain. A cross-sectional view of the spinal cord (Figure 10-10) reveals an
inner region of gray ma er (containing cell bodies and dendrites) and
an outer region of white ma er (containing the nerve fiber tracts with
myelin sheaths) conducting impulses to and from the brain.
FIGURE 10-10 The spinal cord, showing gray and white
matter (transverse view). Afferent neurons bring impulses from
a sensory receptor (such as the skin) into the spinal cord.
Efferent neurons carry impulses from the spinal cord to effector
organs (such as skeletal muscle). The central canal is the space
through which CSF travels.
Meninges
The meninges are three layers of connective tissue membranes that
surround the brain and spinal cord. Label Figure 10-11 as you study the
following description of the meninges.
618
FIGURE 10-11 The meninges, posterior view.
The outermost membrane of the meninges is the dura mater [1]. This
thick, tough membrane contains channels (dural sinuses) that contain
blood. The subdural space [2] is below the dural membrane. The second
layer surrounding the brain and spinal cord is the arachnoid membrane
[3]. The arachnoid (spider-like) membrane is loosely a ached to the
other meninges by web-like fibers, so there is a space for fluid between
the fibers and the third membrane. This is the subarachnoid space [4],
containing CSF. The third layer of the meninges, closest to the brain and
spinal cord, is the pia mater [5]. It contains delicate (Latin pia)
connective tissue with a rich supply of blood vessels. Most physicians
refer to the pia and arachnoid membranes together as the pia-arachnoid.
Vocabulary
This list reviews the new terms introduced in the text. Short definitions
reinforce your understanding of the terms. Refer to the Pronunciation
of Terms section for help with unfamiliar or more difficult words.
619
acetylcholine
afferent nerve
arachnoid
membrane
astrocyte
autonomic
nervous system
axon
blood-brain
barrier
brainstem
cauda equina
cell body
central nervous
system (CNS)
cerebellum
cerebral cortex
cerebrospinal
fluid (CSF)
cerebrum
Neurotransmi er chemical released at the ends of nerve cells.
Carries messages toward the brain and spinal cord (sensory nerve).
Afferent comes from af- (a form of ad-, meaning toward) and -ferent
(meaning carrying).
Middle layer of the three membranes (meninges) that surround the brain
and spinal cord. The Greek arachne means spider.
Type of glial (neuroglial) cell that transports water and salts from
capillaries in the nervous system.
Nerves that control involuntary body functions of muscles, glands, and
internal organs.
Microscopic fiber that is part of a neuron and carries nervous impulse
along a nerve cell.
Protective separation between the blood and brain cells. This makes it
difficult for substances (such as anticancer drugs) to penetrate capillary
walls and enter the brain.
Posterior portion of the brain that connects the cerebrum with the spinal
cord; includes the midbrain, pons, and medulla oblongata.
Collection of spinal nerves below the end of the spinal cord.
Part of a nerve cell that contains the nucleus.
Brain and spinal cord.
Posterior part of the brain that coordinates muscle movements and
maintains balance.
Outer region of the cerebrum, containing sheets of nerve cells; gray
ma er of the brain.
Circulates throughout the brain and spinal cord.
Largest part of the brain; responsible for voluntary muscular activity,
vision, speech, taste, hearing, thought, and memory.
cranial nerves
Nerves carry messages to and from the brain to all parts of head and
neck and also (in the case of the vagus nerve) to other parts of the body.
There are 12 pairs of cranial nerves.
dendrite
Microscopic branching fiber of a nerve cell (neuron) that is the first part
to receive the nervous impulse.
dura mater
Thick, outermost layer of the meninges surrounding and protecting the
brain and spinal cord. Latin for “hard mother.”
efferent nerve
Carries messages away from the brain and spinal cord; motor nerve.
Efferent comes from ef- (meaning away from) and -ferent (meaning to
carry).
ependymal cell Glial cell that lines membranes within the brain and spinal cord and
helps form cerebrospinal fluid.
ganglion (plural: Collection of nerve cell bodies in the peripheral nervous system.
ganglia)
glial cell
Supportive and connective nerve cell that does not carry nervous
(neuroglial cell) impulses. Examples are astrocytes, microglial cells, ependymal cells, and
oligodendrocytes. Glial cells can reproduce themselves, as opposed to
neurons.
gyrus (plural:
Sheet of nerve cells that produces a rounded ridge on the surface of the
gyri)
cerebral cortex; convolution.
hypothalamus
Portion of the brain beneath the thalamus; controls sleep, appetite, body
temperature, and secretions from the pituitary gland.
medulla
Part of the brain just above the spinal cord; controls breathing, heartbeat,
oblongata
and the size of blood vessels; nerve fibers cross over here.
meninges
Three protective membranes that surround the brain and spinal cord.
620
microglial cell
midbrain
motor nerve
myelin sheath
nerve
neuron
neurotransmi er
oligodendroglial
cell
parasympathetic
nerves
parenchyma
peripheral
nervous system
pia mater
plexus (plural:
plexuses)
pons
receptor
sciatic nerve
sensory nerve
spinal nerves
stimulus (plural:
stimuli)
stroma
sulcus (plural:
sulci)
sympathetic
nerves
synapse
thalamus
Phagocytic glial cell that removes waste products from the central
nervous system.
Uppermost portion of the brainstem.
Carries messages away from the brain and spinal cord to muscles and
organs; efferent nerve.
Covering of white fa y tissue that surrounds and insulates the axon of a
nerve cell. Myelin speeds impulse conduction along axons.
Macroscopic cord-like collection of fibers (axons) that carry electrical
impulses.
Nerve cell that is necessary for impulses to be carried throughout the
nervous system; parenchyma of the nervous system.
Chemical messenger released at the end of a nerve cell. It stimulates or
inhibits another cell, which can be a nerve cell, muscle cell, or gland cell.
Examples of neurotransmi ers are acetylcholine, norepinephrine,
dopamine, and serotonin.
Glial cell that forms the myelin sheath covering axons. Also called
oligodendrocyte.
Involuntary autonomic nerves that regulate normal body functions such
as heart rate, breathing, and muscles of the gastrointestinal tract.
Essential, distinguishing tissue of any organ or system. The parenchyma
of the nervous system includes the neurons and nerves that carry
nervous impulses. Parenchymal cells of the liver are hepatocytes, and
parenchymal tissue of the kidney includes the nephrons, where urine is
formed. Note the pronunciation: păr-ĔN-kĭ-mă.
Nerves outside the brain and spinal cord: cranial, spinal, and autonomic
nerves.
Thin, delicate inner membrane of the meninges.
Large, interlacing network of nerves. Examples are lumbosacral, cervical,
and brachial (brachi/o means arm) plexuses. The term originated from
the Indo-European plek, meaning to weave together.
Part of the brain anterior to the cerebellum and between the medulla and
the rest of the midbrain. It is a bridge connecting various parts of the
brain. In Latin, pons means bridge.
Organ that receives and transmits a stimulus to sensory nerves. The skin,
ears, eyes, and taste buds are receptors.
Nerve extending from the base of the spine down the thigh, lower leg,
and foot. Sciatica is pain or inflammation along the course of the nerve.
Carries messages toward the brain and spinal cord from a receptor;
afferent nerve.
Pairs of nerves, arising one on each side of the spinal column. They
transmit messages to and from the spinal cord.
Agent of change in the internal or external environment that evokes a
response. It may be light, sound, touch, pressure, or pain.
Connective and supporting tissue of an organ. Glial cells make up the
stromal tissue of the brain.
Depression or groove in the surface of the cerebral cortex; fissure.
Autonomic nerves that influence bodily functions involuntarily in times
of stress.
Space through which a nervous impulse travels between nerve cells or
between nerve and muscle or glandular cells. From the Greek synapsis, a
point of contact.
Main relay center of the brain. It conducts impulses between the spinal
cord and the cerebrum; incoming sensory messages are relayed through
621
the thalamus to appropriate centers in the cerebrum. Latin thalamus
means room. The Romans, who named this structure, thought this part
of the brain was hollow, like a li le room.
vagus nerve
Tenth cranial nerve (cranial nerve X). Its branches reach to the larynx,
trachea, bronchi, lungs, aorta, esophagus, and stomach. Latin vagus
means wandering. Unlike the other cranial nerves, the vagus leaves the
head and “wanders” into the abdominal and thoracic cavities.
ventricles of the Canals in the brain that contain cerebrospinal fluid. Ventricles are also
brain
found in the heart—they are the two lower chambers of the heart.
Terminology
This section is divided into terms that describe organs and structures of
the nervous system and those that relate to neurologic signs and
symptoms. Write the meanings of the medical terms in the spaces
provided.
Organs and Structures
622
COMBINING
MEANING
FORM
cerebell/o
cerebellum
cerebr/o
cerebrum
dur/o
encephal/o
gli/o
lept/o
mening/o,
meningi/o
my/o
myel/o
neur/o
pont/o
TERMINOLOGY
MEANING
cerebellar ______________________________________
cerebrospinal fluid
______________________________________
cerebral cortex
______________________________________
Cortical means pertaining to the cortex or outer area of an
organ.
dura mater
subdural hematoma
______________________________________
Remember: Hematomas are not tumors of blood, but are
collections of blood.
epidural hematoma
______________________________________
Figure 10-12 shows subdural, epidural, and intracerebral
hematomas.
brain
encephalitis ______________________________________
encephalopathy
______________________________________
Chronic traumatic encephalopathy (CTE) is a progressive
degenerative disease associated with repetitive brain trauma
(concussion).
anencephaly ______________________________________
A congenital brain malformation; not compatible with life and
may be detected with amniocentesis or ultrasonography of the
fetus.
glial cells
glioblastoma ______________________________________
This is a highly malignant tumor (-blast means immature).
Gliomas are tumors of glial (neuroglial) cells.
thin, slender
leptomeningeal
______________________________________
The pia and arachnoid membranes are known as the
leptomeninges because of their thin, delicate structure.
membranes, meningeal ______________________________________
meninges
meningioma ______________________________________
Slowly growing, benign tumor.
myelomeningocele
______________________________________
Neural tube defect caused by failure of the neural tube to close
during embryonic development. This abnormality occurs in
infants born with spina bifida. See page 341.
muscle
myoneural ______________________________________
spinal cord myelopathy ______________________________________
(means bone
poliomyelitis ______________________________________
marrow in
Polio- means gray ma er. This viral disease affects the gray
other
ma er of the spinal cord, leading to paralysis of muscles that
contexts)
rely on the damaged neurons. Effective vaccines developed in
the 20th century have made “polio” relatively uncommon.
nerve
neuropathy ____________
polyneuritis ____________________________________
pons
cerebellopontine
____________________________________
The suffix -ine means pertaining to.
623
COMBINING
MEANING
FORM
radicul/o
nerve root
(of spinal
nerves)
thalam/o
thec/o
vag/o
TERMINOLOGY
MEANING
radiculopathy ____________________________________
Sciatica is a radiculopathy affecting the sciatic nerve root in
the back. A herniated disk is a common cause leading to pain,
weakness, or numbness down the leg. See In Person: Sciatica
story on page 356.
radiculitis ____________________________________
This condition often results in pain and loss of function.
thalamus
thalamic ____________________________________
sheath
intrathecal injection
(refers to the
____________________________________
meninges)
Chemicals, such as chemotherapeutic drugs, can be delivered
into the subarachnoid space.
vagus nerve
vagal ____________________________________
(10th cranial
This cranial nerve has branches to the head and neck, as well
nerve)
as to the chest.
FIGURE 10-12 Hematomas. A subdural hematoma results
from the tearing of veins between the dura and arachnoid
membranes. It often is the result of blunt trauma, such as from
blows to the head in boxers or in elderly patients who have fallen
out of bed. An epidural hematoma occurs between the skull and
the dura as the result of a ruptured meningeal artery, usually after
a fracture of the skull. An intracerebral hematoma is caused by
bleeding directly into brain tissue, such as can occur in the case
of uncontrolled hypertension (high blood pressure).
Signs and Symptoms
624
COMBINING
FORM OR
MEANING TERMINOLOGY
MEANING
SUFFIX
alges/o, sensitivity to analgesia ______________________________________
algesia
pain
hypalgesia ______________________________________
Diminished sensation to pain. (Notice that the o in hypo- is
dropped.) Hyperalgesia is increased sensitivity to pain.
-algia
pain (see
neuralgia ______________________________________
page 355 for
Trigeminal neuralgia involves flashes of pain radiating along
information
the course of the trigeminal nerve (fifth cranial nerve).
on pain
cephalgia ______________________________________
medications)
Headaches may result from tension in neck and scalp muscles.
caus/o
burning
causalgia ______________________________________
Intense burning pain following injury to a sensory nerve.
comat/o
deep sleep
comatose ______________________________________
(coma)
A coma is a state of unconsciousness from which the patient
cannot be aroused. Semicomatose refers to a stupor
(unresponsiveness) from which a patient can be aroused. In an
irreversible coma (brain death), there is complete
unresponsitivity to stimuli, no spontaneous breathing or
movement, and a flat electroencephalogram (EEG) tracing.
esthesi/o, feeling,
anesthesia ______________________________________
esthesia
nervous
Lack of normal sensation (e.g., absence of sense of touch or
sensation
pain). Two common types of regional anesthesia are spinal and
epidural (caudal) blocks (Figure 10-13). An anesthesiologist
is a physician who administers anesthesia.
Anesthetics are agents that reduce or eliminate sensation.
General and local anesthetics are listed in Table 21-2, page
829.
hyperesthesia
______________________________________
Abnormally intense sensation to a particular stimulus, such as
a light touch with a pin. Diminished sensitivity to pain is
called hypesthesia.
paresthesia ______________________________________
Par- (from para-) means abnormal. Paresthesias include
tingling, burning, and “pins and needles” sensations.
kines/o,
movement
bradykinesia ______________________________________
kinesi/o hyperkinesis ______________________________________
kinesia, Amphetamines (CNS stimulants) are used to treat
kinesis, hyperkinesia in children, but the mechanism of their action is
kinetic
not understood.
dyskinesia ______________________________________
Condition marked by involuntary, spasmodic movements.
Tardive (occurring late) dyskinesia may develop in people
who receive certain antipsychotic drugs for extended periods.
akinetic ______________________________________
-lepsy
seizure
epilepsy ______________________________________
See page 343.
narcolepsy ______________________________________
Sudden, uncontrollable compulsion to sleep (narc/o = stupor,
sleep). Amphetamines and stimulant drugs are prescribed to
prevent a acks.
625
COMBINING
FORM OR
MEANING
SUFFIX
lex/o
word,
phrase
-paresis
weakness
-phasia
speech
-plegia
paralysis
(loss or
impairment
of the ability
to move
parts of the
body)
-praxia
action
-sthenia
strength
syncop/o
to cut off,
cut short
tax/o
order,
coordination
TERMINOLOGY
MEANING
dyslexia ______________________________________
This is a developmental reading disorder occurring when the
brain does not properly recognize, process, and interpret
language.
hemiparesis ______________________________________
Affects either right or left side (half) of the body. Paresis also
is used by itself to mean partial paralysis or weakness of
muscles.
aphasia ______________________________________
Difficulty with speech. Motor (also called Broca or expressive)
aphasia is present when the patient knows what he or she
wants to say but cannot say it. The patient with sensory
aphasia has difficulty understanding language and may
pronounce (articulate) words easily but use them
inappropriately.
hemiplegia ______________________________________
Affects the right or left half of the body and results from a
stroke or other brain injury. The hemiplegia is contralateral to
the brain lesion because motor nerve fibers from the right half
of the brain cross to the left side of the body (in the medulla
oblongata).
paraplegia ______________________________________
Originally, the term paraplegia meant a stroke (paralysis) on
one side (para-). Now, however, the term means paralysis of
both legs and the lower part of the body caused by injury or
disease of the spinal cord or cauda equina.
quadriplegia ______________________________________
Quadri- means four. All four extremities are affected. Injury is
at the cervical level of the spinal cord.
apraxia ______________________________________
Movements and behavior are not purposeful. A patient with
motor apraxia cannot use an object or perform a task. Motor
weakness is not the cause.
neurasthenia ______________________________________
Nervous exhaustion and fatigue, often following depression.
syncopal ______________________________________
Syncope (SIN-ko-pe) means fainting; sudden and temporary
loss of consciousness caused by inadequate flow of blood to the
brain. The term comes from a Greek word meaning cu ing
into pieces—thus, a fainting spell meant one's strength was
“cut off.” HINT: Syncopal means pertaining to fainting and
is an adjective. A patient can experience a syncopal episode.
ataxia ______________________________________
Condition of decreased coordination. Persistent unsteadiness
on the feet can be caused by a disorder involving the
cerebellum.
626
FIGURE 10-13 A, Positioning of a patient for spinal
anesthesia. B, Cross-sectional view of the spinal cord showing
injection sites for epidural and spinal blocks (anesthesia).
Epidural (caudal) anesthesia is achieved by injecting an agent
into the epidural space and is commonly used in obstetrics.
Spinal anesthesia is achieved by injecting a local anesthetic into
the subarachnoid space. Patients may experience loss of
sensation and paralysis of feet, legs, and abdomen.
myel/o and my/o
Don't confuse these combining forms. Myel/o means spinal cord or
bone marrow, while my/o means muscle. Another pair to watch out for
is pyel/o (renal pelvis of the kidney) and py/o (pus).
Neuropathies
Neuropathies are diseases of peripheral nerves. They can affect motor,
sensory, and autonomic functions. Polyneuropathies affect many
nerves, while mononeuropathies affect individual nerves.
627
Pathology
The bones of the skull, the vertebral column, and the meninges,
containing CSF, provide a hard box with an interior cushion around the
brain and spinal cord. In addition, glial cells surrounding neurons form
a blood-brain barrier that prevents many potentially harmful substances
in the bloodstream from gaining access to neurons. However, these
protective factors are counterbalanced by the extreme sensitivity of
nerve cells to oxygen deficiency (brain cells die in a few minutes when
deprived of oxygen).
Neurologic disorders may be classified in the following categories:
• Congenital
• Degenerative, movement, and seizure
• Infectious (meningitis and encephalitis)
• Neoplastic (tumors)
• Traumatic
• Vascular (stroke)
Congenital Disorders
hydrocephalus
spina bifida
Abnormal accumulation of fluid (CSF) in the brain.
If circulation of CSF in the brain or spinal cord is impaired, fluid
accumulates under pressure in the ventricles of the brain. To relieve
pressure on the brain, a catheter (shunt) can be placed from the
ventricle of the brain into the peritoneal space (ventriculoperitoneal
shunt) or right atrium of the heart so that the CSF is continuously
drained from the brain.
Hydrocephalus also can occur in adults as a result of tumors and
infections.
Congenital defects in the lumbar spinal column caused by imperfect
union of vertebral parts (neural tube defect).
In spina bifida occulta, the vertebral defect is covered over with skin
and evident only on x-ray or other imaging examination. Spina bifida
cystica is a more severe form, with cyst-like protrusions. In
meningocele, the meninges protrude to the outside of the body, and in
myelomeningocele (or meningomyelocele), both the spinal cord and
meninges protrude (Figure 10-14A and B).
The etiology of neural tube defects is unknown. Defects originate in
the early weeks of pregnancy as the spinal cord and vertebrae develop.
Prenatal diagnosis is helped by imaging methods and testing maternal
blood samples for alpha-fetoprotein.
628
FIGURE 10-14 A, Spina bifida (neural tube defects). B, Spina
bifida cystica with myelomeningocele.
Degenerative, Movement, and Seizure Disorders
629
Alzheimer
disease (AD)
(Alzheimer's)
amyotrophic
lateral
sclerosis
(ALS)
epilepsy
Huntington
Brain disorder marked by gradual and progressive mental
deterioration (dementia), personality changes, and impairment of
daily functioning.
Characteristics of AD include confusion, memory failure,
disorientation, restlessness, and speech disturbances. Anxiety,
depression, and emotional disturbances can occur as well. The disease
sometimes begins in middle life with slight defects in memory and
behavior, but can worsen after the age of 70. On autopsy there is
frequently atrophy of the cerebral cortex and widening of the cerebral
sulci, especially in the frontal and temporal regions (Figure 10-15A and
B). Microscopic examination shows senile plaques resulting from
degeneration of neurons and neurofibrillary tangles (bundles of fibrils
in the cytoplasm of a neuron) in the cerebral cortex. Deposits of
amyloid (a protein) occur in neurofibrillary tangles, senile plaques, and
blood vessels. The cause of AD remains unknown, although genetic
factors may play a role. A mutation on chromosome 14 has been linked
to familial cases. There is as yet no effective treatment.
Degenerative disorder of motor neurons in the spinal cord and
brainstem.
ALS manifests in adulthood. Signs and symptoms are weakness and
atrophy of muscles in the hands, forearms, and legs; difficulty in
swallowing and talking and dyspnea develop as the throat and
respiratory muscles become affected. Etiology (cause) and cure for ALS
both are unknown.
A famous baseball player, Lou Gehrig, became a victim of this disease
in the mid-1900s, so the condition became known as Lou Gehrig
disease.
Chronic brain disorder characterized by recurrent seizure activity.
Seizures are abnormal, sudden discharges of electrical activity within
the brain. Seizures often are symptoms of underlying brain pathologic
conditions, such as brain tumors, meningitis, vascular disease, or scar
tissue from a head injury. Tonic-clonic seizures (grand mal or ictal
events) are characterized by a sudden loss of consciousness, falling
down, and then tonic contractions (stiffening of muscles) followed by
clonic contractions (twitching and jerking movements of the limbs).
These convulsions often are preceded by an aura, which is a peculiar
sensation experienced by the affected person before onset of a seizure.
Dizziness, numbness, and visual or olfactory (sense of smell)
disturbances are examples of an aura. Absence seizures are a form of
seizure consisting of momentary clouding of consciousness and loss of
awareness of the person's surroundings. These include petit mal
seizures in children. Drug therapy (anticonvulsants) is used for control
of epileptic seizures. After seizures, there may be neurologic symptoms
such as weakness called postictal events.
In temporal lobe epilepsy, seizures begin in the temporal lobe (on
each side of the brain near the ears) of the brain. The most common
type of seizure is a complex partial seizure. Complex means impaired
consciousness and partial indicates not generalized. Commonly these
patients have seizures that cause them to pause in whatever they are
doing, become confused, and have memory problems.
The term epilepsy comes from the Greek epilepsis, meaning a laying
hold of. The Greeks thought a victim of a seizure was laid hold of by
some mysterious force. The word ictal originates from the Latin ictus,
meaning a blow or a stroke.
Hereditary disorder marked by degenerative changes in the
630
disease
(Huntington's)
multiple
sclerosis (MS)
myasthenia
gravis (MG)
palsy
Parkinson
disease
(Parkinson's)
cerebrum leading to abrupt involuntary movements and mental
deterioration.
In this genetic condition, symptoms typically begin in adulthood and
include personality changes, along with choreic (meaning dance-like)
movements (uncontrollable, irregular jerking movements of the arms
and legs and facial grimacing). It is also known as Huntington chorea.
The genetic defect in patients with Huntington disease is located on
chromosome 4. Patients can be tested for the gene; however, no cure
exists, and management is symptomatic.
Destruction of the myelin sheath on neurons in the CNS and its
replacement by plaques of sclerotic (hard) tissue.
One of the leading causes of neurologic disability in persons 20 to 40
years of age, MS is a chronic disease often marked by long periods of
stability (remission) and worsening (relapse). Demyelination (loss of
myelin insulation) prevents the conduction of nerve impulses through
the axon. See Figure 10-16A. Demyelination causes paresthesias,
muscle weakness, unsteady gait (manner of walking), and paralysis.
There may be visual (blurred and double vision) and speech
disturbances as well. Areas of scarred myelin (plaques) can be seen on
MRI scans of the brain (Figure 10-16B). Etiology is unknown but
probably involves an autoimmune disease of lymphocytes reacting
against myelin. There are now many helpful disease-modifying drugs
for treating MS. These drugs affect either the inflammation or the
immunological abnormalities in the CNS associated with this illness.
Autoimmune neuromuscular disorder characterized by weakness of
voluntary muscles.
MG is a chronic autoimmune disorder. Antibodies block the ability of
acetylcholine (neurotransmi er) to transmit the nervous impulse from
nerve to muscle cell. Onset of symptoms usually is gradual. Brainstem
signs are prominent and include ptosis of the upper eyelid, double
vision (diplopia), and facial weakness. Respiratory paralysis is the
main clinical concern. Therapy to reverse symptoms includes
anticholinesterase drugs, which inhibit the enzyme that breaks down
acetylcholine. Immunosuppressive therapy is used, including
medications such as corticosteroids (prednisone) and other
immunosuppressive drugs. Thymectomy is also a method of treatment
and is beneficial to many patients.
Paralysis (partial or complete loss of motor function).
Cerebral palsy is partial paralysis and lack of muscular coordination
caused by loss of oxygen (hypoxia) or blood flow to the cerebrum
during pregnancy or in the perinatal period. Bell palsy (or Bell's palsy)
(Figure 10-17) is paralysis on one side of the face. The likely cause is a
viral infection, and therapy is directed against the virus (antiviral
drugs) and nerve swelling (corticosteriods).
Degeneration of neurons in the basal ganglia, occurring in later life
and leading to tremors, weakness of muscles, and slowness of
movement.
This slowly progressive condition is caused by a deficiency of
dopamine, a neurotransmi er made by cells in the basal ganglia (see
Figure 10-9). Motor disturbances include stooped posture, shuffling
gait, and muscle stiffness (rigidity). Other signs are a typical “pillrolling” tremor of hands and a characteristic mask-like lack of facial
expression. See Figure 10-18.
Therapy with drugs such as levodopa plus carbidopa (Sinemet) to
increase dopamine levels in the brain is palliative (relieving symptoms
631
Toure e
syndrome
(Toure e's)
but not curative). Many patients may have clinical features of
Parkinson's (parkinsonism) and yet not have the disease itself. They
would not benefit from antiparkinsonian medication. Some patients
with Parkinson's may benefit from stimulation by electrodes placed
surgically in the brain. Implantation of fetal brain tissue containing
dopamine-producing cells is an experimental treatment but has
produced uncertain results.
Involuntary spasmodic, twitching movements; uncontrollable vocal
sounds; and inappropriate words.
These involuntary movements, usually beginning with twitching of the
eyelid and muscles of the face accompanied by verbal outbursts, are
called tics. Although the cause of Toure e syndrome is not known, it is
associated with either an excess of dopamine or a hypersensitivity to
dopamine. Psychological problems do not cause Toure e syndrome,
but physicians have had some success in treating it with the
antipsychotic drug haloperidol (Haldol), antidepressants, and mood
stabilizers.
FIGURE 10-15 A, Alzheimer disease. Generalized loss of
brain parenchyma (neuronal tissue) results in narrowing of the
cerebral gyri and widening of the sulci. B, Cross-sectional
comparison of a normal brain and a brain from a person with
Alzheimer disease.
632
FIGURE 10-16 Multiple sclerosis. A, Demyelination of a
nerve cell. B, This MRI scan shows multiple abnormal white
areas that correspond to MS plaques (arrows). The plaques are
scar tissue that forms when myelin sheaths are destroyed.
FIGURE 10-17 A, Bell palsy. Notice the paralysis on the left
side of this man's face: The eyelid does not close properly, the
forehead is not wrinkled as would be expected, and there is clear
paralysis of the lower face. B, The palsy spontaneously resolved
after 6 months.
633
FIGURE 10-18 Primary symptoms of Parkinson disease are
tremors in hands, arms, legs, jaw, and face; rigidity or stiffness of
limbs and trunk; bradykinesia (shuffling gait), stooped posture,
and masklike facies.
Epilepsy and Seizures
Epilepsy is a brain disorder in which at least two or more seizures
appear spontaneously and recurrently. Having a single seizure does
not mean that the affected person has epilepsy.
Infectious Disorders
634
herpes zoster
(shingles)
meningitis
human
immunodeficiency
virus (HIV)
encephalopathy
Viral infection affecting peripheral nerves.
Blisters and pain spread along peripheral nerves (see Figure 1019A) and are caused by inflammation due to a herpesvirus (herpes
zoster), the same virus that causes chickenpox (varicella).
Reactivation of the chickenpox virus (herpes varicella-zoster),
which remains in the body after the person had chickenpox,
occurs. Painful blisters follow the underlying route of cranial or
spinal nerves Shingrix is a vaccine to prevent shingles. It is
recommended for people 50 years of age and older.
Inflammation of the meninges; leptomeningitis.
This condition can be caused by bacteria (pyogenic meningitis) or
viruses (aseptic or viral meningitis). Signs and symptoms are fever
and signs of meningeal irritation, such as headache, photophobia
(sensitivity to light), and a stiff neck. Lumbar punctures are
performed to examine CSF. Physicians use antibiotics to treat the
more serious pyogenic form, and antivirals for the viral form.
Brain disease and dementia occurring with AIDS.
Many patients with AIDS develop neurologic dysfunction. In
addition to encephalitis and dementia (loss of mental functioning),
some patients develop brain tumors and other infections.
FIGURE 10-19 A, Herpes zoster (shingles) in a typical
location around the trunk of the body. Zoster in ancient Greek
means belt or girdle. B, Glioblastoma as seen on MRI.
Neoplastic Disorders
635
brain
tumor
Abnormal growth of brain tissue and meninges.
Most primary brain tumors arise from glial cells (gliomas) or the meninges
(meningiomas). Types of gliomas include astrocytoma (Figure 10-19B),
oligodendroglioma, and ependymoma. The most malignant form of
astrocytoma is glioblastoma multiforme (-blast means immature) (see Figure
10-19B). Tumors can cause swelling (cerebral edema) and hydrocephalus. If CSF
pressure is increased, swelling also may occur near the optic nerve (at the back
of the eye). Other symptoms include severe headache and new seizures.
Gliomas at times can be removed surgically. Brain tumors are also treated with
chemotherapy and radiotherapy. Steroids are used to reduce cerebral edema.
Meningiomas usually are benign and surrounded by a capsule, but they may
cause compression and distortion of the brain.
Tumors in the brain also may be single or multiple metastatic growths. Most
arise from the lung, breast, skin (melanoma), kidney, and gastrointestinal tract
and spread to the brain.
Traumatic Disorders
cerebral
concussion
cerebral
contusion
Type of traumatic brain injury caused by a blow to the head.
There is usually no evidence of structural damage to brain tissue, and loss
of consciousness may not occur. Rest is very important after a concussion
because it allows the brain to heal. Doctors commonly recommend
avoiding demanding mental and physical activities until symptoms have
fully resolved.
Bruising of brain tissue resulting from direct trauma to the head.
A cerebral contusion may be associated with edema and an increase in
intracranial pressure. A skull fracture may be present. Subdural and
epidural hematomas occur (see Figure 10-12), leading to permanent brain
injury with abnormalities such as altered memory or speech as well as
development of epilepsy.
Vascular Disorders
636
cerebrovascular
accident (CVA)
migraine
Disruption in the normal blood supply to the brain; stroke.
This condition, also known as a cerebral infarction, is the result of
impaired oxygen supply to the brain. There are three types of strokes
(Figure 10-20):
1. Thrombotic—blood clot (thrombus) in the arteries leading to the brain,
resulting in occlusion (blocking) of the vessel. Atherosclerosis leads to
this common type of stroke as blood vessels become blocked over time.
Before total occlusion occurs, a patient may experience symptoms that
point to the gradual occlusion of blood vessels. These short episodes of
neurologic dysfunction are known as transient ischemic a acks (TIAs).
2. Embolic—an embolus (a dislodged thrombus) travels to cerebral
arteries and occludes a vessel. This type of stroke occurs very suddenly.
3. Hemorrhagic—a cerebral artery breaks and bleeding occurs. This type
of stroke can be fatal and results from advancing age, atherosclerosis, or
high blood pressure, all of which result in degeneration of cerebral
blood vessels. With small hemorrhages, the body reabsorbs the blood
and the patient makes good recovery with only slight disability. In a
younger patient, cerebral hemorrhage usually is caused by mechanical
injury associated with skull fracture or rupture of an arterial aneurysm
(weakened area in the vessel wall that balloons and may eventually
burst). See Figure 10-21.
The major risk factors for stroke are hypertension, diabetes, smoking,
and heart disease. Other risk factors include obesity, substance abuse
(cocaine), and elevated cholesterol levels.
Thrombotic strokes are treated with antiplatelet or anticoagulant
(clot-dissolving) therapy. Tissue plasminogen activator (tPA) may be
started shortly after the onset of a stroke. Surgical intervention with
carotid endarterectomy (removal of the atherosclerotic plaque along
with the inner lining of the affected carotid artery) also is possible.
Severe, recurring, unilateral, vascular headache.
A migraine may be associated with an aura (peculiar sensations that
precede the onset of illness). Symptoms of aura are temporary visual
and sensory disturbances, including flashes of light and zigzag lines.
Sensitivity to sound (phonophobia) and light (photophobia) are
associated with the migraine itself. The etiology of pain in migraines
is not fully established, but there are clearly changes in cerebral blood
vessels. Treatment to prevent a migraine a ack includes medications
such as sumatriptan succinate (Imitrex) that target serotonin receptors
on blood vessels and nerves. Drugs of this type reduce inflammation
and restrict dilation of blood vessels.
637
FIGURE 10-20 Three types of strokes: embolic, hemorrhagic,
and thrombotic.
FIGURE 10-21 Cerebral aneurysm.
638
Study Section
The following list reviews the new terms used in the Pathology section.
Practice spelling each term and know its meaning.
absence
seizure
aneurysm
Form of seizure consisting of momentary clouding of consciousness and
loss of awareness of surroundings.
Enlarged, weakened area in an arterial wall, which may rupture, leading to
hemorrhage and CVA (stroke).
astrocytoma
Malignant brain tumor of astrocytes (glial brain cells).
aura
Peculiar symptom or sensation occurring before the onset (prodromal) of an
a ack of migraine or an epileptic seizure.
dementia
Mental decline and deterioration.
demyelination Destruction of myelin on axons of neurons (as in multiple sclerosis).
dopamine
CNS neurotransmi er, deficient in patient with Parkinson disease.
embolus
Clot of material that travels through the bloodstream and suddenly blocks a
vessel.
gait
Manner of walking.
ictal event
Pertaining to a sudden, acute onset, as with the convulsions of an epileptic
seizure.
occlusion
Blockage.
palliative
Relieving symptoms but not curing them.
thymectomy Removal of the thymus gland (a lymphocyte-producing gland in the chest);
used as treatment for myasthenia gravis.
TIA
Transient ischemic a ack. TIAs can occur with all three types of strokes:
thrombolytic, embolic, and even hemorrhagic (if minor.) They are
characterized by a limited time course of neurologic deficits.
tic
Involuntary movement of a small group of muscles, as of the face;
characteristic of Toure e syndrome.
tonic-clonic
Major (grand mal) convulsive seizure marked by sudden loss of
seizure
consciousness, stiffening of muscles, and twitching and jerking movements.
639
Laboratory Tests and Clinical
Procedures
Laboratory Tests
cerebrospinal
fluid analysis
Samples of CSF are examined.
CSF analysis measures protein, glucose, and red (RBC) and white
(WBC) blood cells as well as other chemical contents of the CSF. CSF
analysis also can detect tumor cells (by cytology), bacteria, and viruses.
These studies are used to diagnose infection, tumors, or multiple
sclerosis.
Clinical Procedures
X-Ray Tests
cerebral
angiography
computed
tomography
(CT) of the
brain
X-ray imaging of the arterial blood vessels in the brain after injection
of contrast material.
Contrast is injected into the femoral artery (in the thigh), and x-ray
motion pictures are taken. These images diagnose vascular disease
(aneurysm, occlusion, hemorrhage) in the brain.
Computerized x-ray technique that generates multiple images of the
brain and spinal cord.
Contrast material may be injected intravenously to highlight
abnormalities. The contrast leaks through the blood-brain barrier from
blood vessels into the brain tissue and shows tumors, aneurysms,
bleeding, brain injury, skull fractures, and blood clots. Operations are
performed using the CT scan as a local road map. CT scans also are
particularly useful for visualizing blood and bone.
Magnetic Resonance Techniques
magnetic
resonance
imaging
(MRI)
Magnetic field and pulses of radiowave energy create images of the brain
and spinal cord.
MRI is be er than CT at evaluation of brain parenchyma. It is excellent for
viewing brain damage related to infection, inflammation or tumors. It also
is used to look for causes of headaches, to help diagnose a stroke, and to
detect bleeding problems and head injury. Contrast material may be used to
enhance images. Magnetic resonance angiography (MRA) produces
images of blood vessels using magnetic resonance techniques.
Radionuclide Studies
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positron
emission
tomography
(PET) scan
Radioactive glucose is injected and then detected in the brain to image
the metabolic activity of cells.
PET scans provide valuable information about the function of brain tissue
in patients, to detect malignancy and to evaluate brain abnormalities in
Alzheimer disease, stroke, schizophrenia, and epilepsy (Figure 10-22).
Combined PET-CT scanners provide images that pinpoint the location of
abnormal metabolic activity within the brain.
FIGURE 10-22 PET scans. A, Normal brain. B, Brain
affected by Alzheimer disease. Red and yellow areas indicate
high neural activity. Blue and purple indicate low neural activity.
Ultrasound Examination
Doppler
ultrasound studies
Sound waves detect blood flow in the carotid and intracranial
arteries.
The carotid artery carries blood to the brain. These studies detect
occlusion in blood vessels.
Other Procedures
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electroencephalography
(EEG)
lumbar puncture (LP)
stereotactic
radiosurgery
Recording of the electrical activity of the brain.
EEG demonstrates seizure activity resulting from brain
tumors, other diseases, and injury to the brain. It can also
help define diffuse cortical dysfunction (encephalopathies).
CSF is withdrawn from between two lumbar vertebrae for
analysis (Figure 10-23).
A device to measure the pressure of CSF may be a ached to
the end of the needle after it has been inserted. Injection of
intrathecal medicines may be administered as well. Some
patients experience headache after LP. An informal name for
this procedure is “spinal tap.”
Use of a specialized instrument to locate and treat targets in
the brain.
The stereotactic instrument is fixed onto the skull and guides
the insertion of a needle by three-dimensional measurement.
A Gamma Knife (high-energy radiation beam) is used to
treat deep and often inaccessible intracranial brain tumors
and abnormal blood vessel masses (arteriovenous
malformations) without surgical incision. Proton stereotactic
radiosurgery (PSRS) delivers a uniform dose of proton
radiation to a target and spares surrounding normal tissue
(Figure 10-24 A and B).
FIGURE 10-23 Lumbar puncture. The patient lies laterally,
with the knees drawn up to the abdomen and the chin brought
down to the chest. This position increases the spaces between
the vertebrae. The lumbar puncture needle is inserted between
the third and fourth (or the fourth and fifth) lumbar vertebrae and
then is advanced to enter the subarachnoid space.
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FIGURE 10-24 A, Patient in position on stereotactic proton
unit, ready to take an alignment x-ray. B, Stereotactic frame
holds the patient's head in place for treatment with proton beam
radiosurgery. (Courtesy Department of Radiation Therapy,
Massachusetts General Hospital, Boston.)
Abbreviations
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AD
AFP
Alzheimer disease
alpha-fetoprotein; elevated levels in amniotic fluid and maternal blood are
associated with congenital malformations of the nervous system, such as
anencephaly and spina bifida
ALS
amyotrophic lateral sclerosis—Lou Gehrig disease
AVM arteriovenous malformation; congenital tangle of arteries and veins in the cerebrum
BBB
blood-brain barrier
CNS central nervous system
CSF
cerebrospinal fluid
CTE
chronic traumatic encephalopathy
CVA cerebrovascular accident
EEG
electroencephalography
GABA gamma-aminobutyric acid (neurotransmi er)
ICP
intracranial pressure (normal pressure is 5 to 15 mm Hg)
LP
lumbar puncture
MAC monitored anesthetic care
MG
myasthenia gravis
MRA magnetic resonance angiography
MRI
magnetic resonance imaging
MS
multiple sclerosis
hemiparesis
P
PCA
patient-controlled analgesia
PET
positron emission tomography
PNS
peripheral nervous system
PSRS proton stereotactic radiosurgery
Sz
seizure
TBI
traumatic brain injury
TENS transcutaneous electrical nerve stimulation; technique using a ba ery-powered
device to relieve acute and chronic pain
TIA
transient ischemic a ack; temporary interference with the blood supply to the brain
TLE
temporal lobe epilepsy
tPA
tissue plasminogen activator; a clot-dissolving drug used as therapy for stroke
Practical Applications
Case Study: A Patient's Account of Ulnar Nerve
Neuropathy
I am definitely not one of those ambidextrous people. I am a true
righty, so the “experiment” of making me a lefty out of necessity didn't
go so well. Over the past decade, I had slowly lost sensation in my right
pinky and a fair amount of function in my right hand. You might think
that I should have taken care of treating it when it initially presented
itself with an electric shock down my arm from hi ing my “funny
bone” over and over. The “funny bone,” of course, is not a bone at all. It
is the ulnar nerve, which runs across the medial and posterior aspect of
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the elbow as it travels to the hand. See Figure 10-25. After multiple
injuries to my elbow, my pinky just became useless and numb.
FIGURE 10-25 Pathway of ulnar nerve running behind the
elbow joint (median epicondyle of the humerus) and toward the
hand.
As a physician, I realized that my ulnar nerve had become entrapped
and scarred from repeated injury. Over the years, I tolerated this
situation because other nerves had remained unaffected, providing
sensation and function to my hand. It was only when I saw myself in a
video (my hand looked like a claw) that I recognized how
compromised the function of the hand had become.
During an exam by an orthopedic elbow specialist, testing revealed
poor sensation and atrophy of my right hand muscles. My grip strength
was also affected and was now actually stronger on my left rather than
my right.
Surgery was scheduled immediately with hopes of halting atrophy
and clawing of my hand and regaining sensation in my pinky. My
surgeon performed an Eaton procedure. He moved the scarred ulnar
nerve from its vulnerable path and placed sutures to hold the ulnar
nerve in its new place under the fascia (connective tissue) of my elbow.
He created a li le “curtain” with the fascia to keep the nerve from
moving again. This ultimately allowed the nerve to take a “shortcut” on
the way to my hand while taking tension off the injured nerve and
keeping it away from the bony prominence of the elbow.
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When I awoke from the anesthesia, I could immediately tell that
something was different about my hand. I had tingling in my
previously numb fingers and soon had a warm sensation and even
sweating in my palm. These findings demonstrated the return of the
autonomic function of the nerve, something that had also been affected
by the long-standing injury.
My arm was in a sling until my post-op appointment. Figure 10-26
shows my arm and scar just after the 2-week postoperative check. A
compression sleeve prevented swelling and reminded me not to use my
arm too much.
FIGURE 10-26 Post-operative scar from ulnar nerve surgery.
At 3 months postsurgery I was back to my usual routine of typing,
writing, and using my hand. Sensation gradually returned to my pinky,
and the function in my hand improved as well but very slowly. Injured
nerves can regenerate as long as they are not cut or completely crushed.
The nerve heals from proximal to distal (starting at the elbow and
working toward the tip of the finger). Doctors quote the statistic of a
millimeter a day for nerve regeneration, or roughly an inch per month.
The feeling in my pinky is still not normal, but it is improving, and it's
encouraging to notice the progress. The muscles in my hand are also
ge ing stronger. The true test will be to check my grip strength when I
return for my 6-month follow-up appointment.
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I am grateful for the brisk action and skilled surgery that was
possible before my ulnar nerve was permanently damaged. I am also
thankful that the body can heal itself when provided the appropriate
help. I had become so used to the numb feeling that I had no idea of
what I had been missing!
Answers to the following case report and case study questions are on
page 366.
Case Report: Cerebral Infarction
This patient was admi ed on January 14 with a history of progressive
right hemiparesis for the previous 1 to 2 months; fluctuating numbness
of the right arm, thorax, and bu ocks; jerking of the right leg; periods
of speech arrest; diminished comprehension in reading; and recent
development of a hemiplegic gait. Given the gradually progressive
development of neurological difficulties, he was suspected of having a
left parietal tumor. [The parietal lobes of the cerebrum are on either
side under the roof of the skull.]
Examinations done before hospitalization included skull films, EEG,
and CSF analysis, which were all normal. After admission, an MRI was
abnormal in the left parietal region, as was the EEG.
An MRA study to assess cerebral blood vessels was a empted, but
the patient became progressively more restless and agitated after
sedation, so the procedure was stopped. During the recovery phase
from the sedation, the patient was alternately somnolent [sleepy] and
violent, but it was later apparent that he had developed almost a
complete aphasia and right hemiplegia.
In the next few days, he became more alert, although he remained
dysarthric [from the Greek arthroun, to u er distinctly] and hemiplegic.
MRI and MRA with the patient under general anesthesia on January
19 showed complete occlusion of the left internal carotid artery with
cross-filling of the left anterior and middle cerebral arteries from the
right internal carotid circulation.
Final diagnosis: Left CVA caused by left internal carotid artery
occlusion.
[Figure 10-27 shows the common carotid arteries and their branches
within the head and brain.]
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FIGURE 10-27 Common carotid arteries and their branches.
Questions about the Case Report
1. The patient was admi ed with a history of:
a. Right-sided paralysis caused by a previous stroke
b. Paralysis on the left side of his body
c. Increasing paresis on the right side of his body
2. The patient also had experienced periods of:
a. Aphasia and dyslexia
b. Dysplastic gait
c. Apraxia and aphasia
3. After his admission to the hospital, where did the MRI show an
abnormality?
a. Right posterior region of the brain
b. Left and right sides of the brain
c. Left side of the brain
4. What test determined the final diagnosis?
a. EEG for both sides of the brain
b. CSF analysis and cerebral angiography
c. MRI and MRA
5. What was the final diagnosis?
a. Stroke; ischemic injury to tissue in the left cerebrum caused
by blockage of an artery
b. Cross-filling of blood vessels from the left to the right side of
the brain
c. Cerebral palsy on the left side of the brain with cross-filling
of two cerebral arteries
Pain Medications
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Pain is a major symptom in many medical conditions. Both the area of
injury and how the brain deals with it affect the sensations of pain.
Medications to relieve pain (analgesics) act in different ways:
• Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain by
stopping inflammation. Examples are nonprescription drugs such
as ibuprofen (Advil, Motrin, Excedrin), aspirin (Anacin, Ascriptin,
Bufferin), and naproxen (Aleve). Other NSAIDs that require a
prescription are Toradol (ketorolac) and Feldene (piroxicam).
• Acetaminophen (Tylenol) relieves fever and mild pain but is not
an anti-inflammatory drug. It is not clear how acetaminophen
works.
• Opioids (narcotics) relieve pain by affecting receptors in the brain
to control the perception of pain. Examples are morphine, codeine,
oxycodone, and hydrocodone. Combinations of narcotics and
acetaminophen are Vicodin (acetaminophen with hydrocodone)
and Percocet (acetaminophen with oxycodone). Given the
addicting potential for this class of drugs, opioids are, in general,
prescribed only in limited quantities and used sparingly.
Neuropathic Pain with a Case Study
Neuropathic pain is a unique type of pain that accompanies illnesses
and trauma. Patients may describe this pain as:
• radiating or spreading
• an electric shock–like sensation
• hot or burning
• shooting, piercing, darting, or stabbing (lancinating)
• abnormal skin sensations (paresthesias): numbness, tingling, “pins
and needles”
• pain to light touch
• extreme sensitivity to ordinary, innocuous stimuli
• often independent of movement
Case Study:
A 68-year-old man awoke one morning with severe pain in his right
shoulder. On turning his head or lifting his shoulder, he experienced
extreme discomfort and lancinating pain. The pain was a sharp,
burning pain that moved across his shoulder and down into his right
arm. Finding a comfortable position lying down was difficult. A
cervical MRI study showed no bone abnormalities, whereas a
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neurologic examination provided evidence of damage to multiple
peripheral nerves. He developed weakness of his shoulder muscles and
was unable to lift his right arm. Final diagnosis was brachial plexus
neuritis [also known as Parsonage-Turner syndrome]. The cause of the
condition is unknown, but it may be related to a flu vaccination he
received 2 weeks previously. Treatment consisted of pain medication
and physical therapy to rehabilitate weakened muscles in his arm and
shoulder.
Questions about the Case Study
1. The cervical MRI study showed:
a. Damage to the vertebrae in the neck
b. Nerve entrapment in the upper spine
c. Damage to multiple peripheral nerves
d. Normal vertebrae in the neck
2. Lancinating pain is:
a. Pain to light touch
b. Characterized by paresthesia
c. Stabbing, piercing, shooting
d. Characterized by numbness and tingling
3. The patient's diagnosis is best described as:
a. Inflammation of cervical nerve roots affecting his shoulder
and arm
b. Inflammation of a network of nerves in his shoulder that
control muscles in his arm
c. First stages of a heart a ack, marked by radiating arm pain
d. Autoimmune disorder affecting voluntary muscles in his
shoulder and arm
In Person
Sciatica
This is a first-person account of a woman in her mid-forties living with
sciatica.Twelve years ago, I wouldn't have believed that reaching into a
laundry basket could change my life. But in January 2009, it did.
I had go en my first-ever backache a few days earlier, after a long car
trip. A Google search instructed me to apply ice for the first 48 hours
and then heat if the pain persisted. My husband took over the kids'
school-day routine while I recuperated. That third morning, I could
hear my younger son rifling around for his favorite sweatshirt; I knew
it was at the foot of my bed, waiting to be sorted. In the instant it took
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y
g
to reach into the laundry basket for that sweatshirt, my back went from
dull ache to a crippling pain that radiated all the way down my left leg
to the tip of my left foot.
An MRI scan confirmed the diagnosis: spinal disc herniation,
protruding onto the nerve roots affecting the sciatic nerve and causing
my leg pain. With surgery presented as a last resort, I embarked on a
crash course of physical therapy, NSAIDs, oral steroids, muscle
relaxants, epidural steroid injections, and lots and lots of patience. I
saw gradual improvement for about three months, to the point that I
was able to resume a modified daily routine.
Then, the improvement stopped. Conventional treatment had run its
course. I was at the “last resort” stage. So I “cried uncle” and requested
a surgical consult. The surgeon ordered a follow-up MRI, which
showed good news: There had been much improvement to the
herniation. To my surprise, the MRI also revealed that nerve roots
supplying the sciatic nerve were now free and clear of impingement. If
the nerve was back to normal, why was I still in such pain? Because, it
turns out, the nerve was injured by its ordeal. Not uncommon, I was
reassured. This development took the surgical option off the table.
After all, the goal of the surgery would have been to relieve the affected
nerve from compression by the protruding disc. In my case, even the
relieved nerve was causing problems, and that meant not surgery, but
more patience. The wait began: to see whether the nerve would repair
itself—I was told that could take years—or worse, whether I was facing
permanent nerve damage.
Three years later the verdict seems clear: my sciatic nerve sustained
what appears to be permanent damage. To this day, I have not regained
full use of my left leg. Along with chronic, dull pain, there are also
paresthesias—simultaneous burning and numbness along the path of
the sciatic nerve accompanied by constant involuntary muscle spasms.
I've lost my Achilles jerk reflex, and so unresponsive is my left foot that
I can't feel it hit the ground when I'm walking.
In those critical first months, I thought my options were either
resolving the herniation with surgery or resolving it without surgery. It
never once occurred to me that, four years later, the injury would
remain unresolved.
There's always a new treatment, specialist, or drug that shows
promise or that really worked for a friend of a friend. Until recently, it
felt like I was giving up hope if I didn't pursue each lead. Now I'm
focusing more on adapting to my new circumstances than on finding a
“cure.” I don't want my whole life to revolve around sciatica. I found a
medication that reduces the chronic pain to more of an annoyance than
a crisis (with occasional flare-ups).
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I missed my old life and wanted it back. At the risk of sounding like a
late-night pharmaceutical ad, I'm not giving up; I'm going on.
AUTHOR'S NOTE Everyone's experience with sciatica is unique. I have
also experienced the condition myself, resulting from an L4-L5 disk herniation.
After 7 months of pain radiating down my right leg, I had microdiskectomy
surgery, which fortunately alleviated my pain and sciatica.
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Exercises
Remember to check your answers carefully with the Answers to
Exercises, page 364.
A Match the listed neurologic structures with the
descriptions/definitions that follow.
astrocyte
axon
cauda equina
cerebral cortex
dendrite
meninges
myelin sheath
neuron
oligodendroglial cell
plexus
1. microscopic fiber leading from the cell body that
carries the nervous impulse along a nerve cell
_________________________
2. large, interlacing network of nerves
_________________________
3. three protective membranes surrounding the brain
and spinal cord _________________________
4. microscopic branching fiber of a nerve cell that is
the first part to receive the nervous impulse
_________________________
5. outer region of the largest part of the brain;
composed of gray ma er
_______________________
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6. glial cell that transports water and salts between
capillaries and nerve cells ___________________
7. glial cell that produces myelin
_________________________
8. a nerve cell that transmits a nerve impulse
_________________________
9. collection of spinal nerves below the end of the
spinal cord at the level of the second lumbar
vertebra _________________________
10. fa y tissue that surrounds the axon of a nerve cell
_________________________
B Give the meanings of the following terms.
1. dura mater _________________________
2. central nervous system
_________________________
3. peripheral nervous system
_________________________
4. arachnoid membrane _________________________
5. hypothalamus _________________________
6. synapse _________________________
7. sympathetic nerves _________________________
8. medulla oblongata ________________________
9. pons _________________________
10. cerebellum _________________________
11. thalamus _________________________
12. ventricles of the brain _________________________
13. brainstem _________________________
14. cerebrum _________________________
15. ganglion _________________________
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C Match the following terms with the meanings or
associated terms below.
glial cells
gyri
motor nerves
neurotransmi er
parenchymal cell
pia mater
sensory nerves
subarachnoid space
sulci
1. innermost meningeal membrane
_____________________________
2. carry messages away from (efferent) the brain and
spinal cord to muscles and glands
_____________________________
3. carry messages toward (afferent) the brain and
spinal cord from receptors
______________________
4. grooves in the cerebral cortex
_____________________________
5. contains cerebrospinal fluid
_____________________________
6. elevations in the cerebral cortex
_____________________________
7. chemical that is released at the end of a nerve cell
and stimulates or inhibits another cell (example:
acetylcholine) _____________________________
8. essential cell of the nervous system; a neuron
_____________________________
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9. connective and supportive (stromal) tissue
_____________________________
D Circle the correct boldface term for the given
definition.
1. disease of the brain (encephalopathy, myelopathy)
2. part of the brain that controls muscular
coordination and balance (cerebrum, cerebellum)
3. collection of blood above the dura mater (subdural
hematoma, epidural hematoma)
4. inflammation of the pia and arachnoid membranes
(leptomeningitis, causalgia)
5. condition of absence of a brain (hypalgesia,
anencephaly)
6. inflammation of the gray ma er of the spinal cord
(poliomyelitis, polyneuritis)
7. pertaining to the membranes around the brain and
spinal cord (cerebellopontine, meningeal)
8. disease of nerve roots (of spinal nerves)
(neuropathy, radiculopathy)
9. hernia of the spinal cord and meninges
(myelomeningocele, meningioma)
10. pertaining to the tenth cranial nerve (thalamic,
vagal)
E Give the meanings of the following terms.
1. cerebral cortex
_____________________________________________
________________________
2. intrathecal
_____________________________________________
________________________
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3. polyneuritis
_____________________________________________
________________________
4. thalamic
_____________________________________________
________________________
5. myelopathy
_____________________________________________
________________________
6. meningioma
_____________________________________________
________________________
7. glioma
_____________________________________________
_______________________
8. subdural hematoma
_____________________________________________
____________________
F Match the listed neurologic symptoms with the
definitions/descriptions that follow.
aphasia
ataxia
bradykinesia
causalgia
dyslexia
hemiparesis
hyperesthesia
motor apraxia
narcolepsy
neurasthenia
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paraplegia
syncope
1. reading disorder
_______________________________
2. condition of decreased coordination
_______________________________
3. condition of slow movement
_______________________________
4. condition of increased sensation
_______________________________
5. seizure of sleep; uncontrollable compulsion to sleep
_______________________________
6. difficulty with speech
_______________________________
7. inability to perform a task
_______________________________
8. weakness in the right or left half of the body
_______________________________
9. severe burning pain due to nerve injury
_______________________________
10. paralysis in the lower part of the body
_______________________________
11. fainting _______________________________
12. nervous exhaustion (lack of strength) and fatigue
_______________________________
G Give the meanings of the following terms.
1. analgesia
_____________________________________________
___________________________
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2. motor aphasia
_____________________________________________
_______________________
3. paresis
_____________________________________________
____________________________
4. quadriplegia
_____________________________________________
_________________________
5. asthenia
_____________________________________________
_____________________________
6. comatose
_____________________________________________
__________________________
7. paresthesia
_____________________________________________
__________________________
8. hyperkinesis
_____________________________________________
_________________________
9. anesthesia
_____________________________________________
__________________________
10. causalgia
_____________________________________________
___________________________
11. akinetic
_____________________________________________
_____________________________
659
12. hypalgesia
_____________________________________________
___________________________
13. dyskinesia
_____________________________________________
___________________________
14. migraine
_____________________________________________
___________________________
H Match the listed neurologic pathology terms with
the descriptions that follow. The terms in boldface
are clues!
Alzheimer disease
amyotrophic lateral sclerosis
Bell palsy
epilepsy
Huntington disease
hydrocephalus
multiple sclerosis
myasthenia gravis
Parkinson disease
myelomeningocele
1. Destruction of myelin sheath (demyelination) and
its replacement by hard plaques:
_______________________________
2. Sudden, transient disturbances of brain function
cause seizures: ___________________________
3. The spinal column is imperfectly joined (a split in
a vertebra occurs), and part of the meninges and
660
spinal cord can herniate out of the spinal cavity:
_______________________________
4. Atrophy of muscles and paralysis caused by
damage to motor neurons in the spinal cord and
brainstem: _______________________________
5. Patient displays bizarre, abrupt, involuntary,
dance-like movements, as well as decline in mental
functions: _______________________________
6. Cerebrospinal fluid accumulates in the head (in the
ventricles of the brain): _________________
7. Loss of muscle strength due to the inability of a
neurotransmi er (acetylcholine) to transmit
impulses from nerve cells to muscle cells:
_______________________________
8. Degeneration of nerves in the basal ganglia
occurring in later life, leading to tremors, shuffling
gait, and muscle stiffness; dopamine
(neurotransmi er) is deficient in the brain:
_______________________________
9. Deterioration of mental capacity (dementia);
autopsy shows cerebral cortex atrophy, widening
of cerebral sulci, and microscopic neurofibrillary
tangles: _______________________________
10. Unilateral facial paralysis:
_______________________________
I Give the meanings of the following terms for
abnormal conditions.
1. astrocytoma
_____________________________________________
________________________
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2. pyogenic meningitis
_____________________________________________
_________________
3. Toure e syndrome
_____________________________________________
___________________
4. cerebral contusion
_____________________________________________
___________________
5. cerebrovascular accident
_____________________________________________
______________
6. cerebral concussion
_____________________________________________
_________________
7. herpes zoster
_____________________________________________
________________________
8. cerebral embolus
_____________________________________________
___________________
9. cerebral thrombosis
_____________________________________________
__________________
10. cerebral hemorrhage
_____________________________________________
_________________
11. cerebral aneurysm
_____________________________________________
___________________
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12. HIV encephalopathy
_____________________________________________
__________________
J Match the term in Column I with the le er of its
description or meaning in Column II.
COLUMN I
1. ataxia
2. aura
3. transient ischemic a ack
4. tonic-clonic seizure
5. herpes zoster
6. palliative
7. dopamine
8. occlusion
9. absence seizure
10. glioblastoma
multiforme
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
COLUMN II
A. relieving, but not curing
B. virus that causes chickenpox and shingles
C. uncoordinated gait
D. neurotransmi er
E. peculiar sensation experienced by patient before onset of
seizure
F. malignant brain tumor of immature glial cells
G. major epileptic seizure; ictal event
H. blood flow to the brain stops for a brief period of time
I. minor epileptic seizure
J. blockage
K Describe what happens in the following two
procedures.
1. MRI of the brain:
_____________________________________________
______________________
2. stereotactic radiosurgery with Gamma Knife:
____________________________________________
_____________________________________________
_____________________________________
L Match these easily confused terms for neurologic
pathology with the meanings/descriptions that
follow.
analgesia
anesthesia
aphasia
apraxia
ataxia
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dyskinesia
dyslexia
hyperkinesia
neurasthenia
paresis
paresthesia
1. lack of nerve strength _________________________
2. inability to speak _________________________
3. inability to perform purposeful actions
_________________________
4. condition of insensitivity to pain
_________________________
5. condition of loss of sensation
_________________________
6. sensations of tingling, numbness, or “pins and
needles” _________________________
7. lack of coordination _________________________
8. excessive movement _________________________
9. abnormal, involuntary, spasmodic movements
_________________________
10. developmental reading disorder
_________________________
11. partial paralysis _________________________
M Spell out the abbreviations in Column I, and then
select the le er of the best association from Column
II for each.
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COLUMN I
1. EEG
_______________
2. PET
________________
3. AFP
________________
4. MS
________________
5. MRI
________________
6. LP
_________________
7. CVA
________________
8. AD
_________________
9. TIA
_________________
10. CSF
________________
_______
_______
_______
_______
_______
_______
_______
_______
_______
COLUMN II
A. Gradually progressive dementia.
B. Stroke; embolus, hemorrhage, and thrombosis are etiologic factors.
C. Intrathecal medications can be administered through this procedure.
D. This fluid is analyzed for abnormal blood cells, chemicals, and
protein.
E. Procedure to diagnose abnormal electrical activity in the brain.
F. Neurologic symptoms and/or signs due to temporary interference of
blood supply to the brain.
G. High levels in amniotic fluid and maternal blood are associated with
spina bifida.
H. Diagnostic procedure that allows excellent visualization of soft
tissue in the brain.
I. Radioactive materials, such as glucose, are taken up by the brain, and
images recorded.
J. Destruction of the myelin sheath in the CNS occurs with plaques of
hard scar tissue.
_______
N Circle the boldface terms that complete the
meanings of the sentences.
1. Maria had such severe headaches that she could
find relief only with strong analgesics. Her
condition of (spina bifida, migraine, epilepsy) was
debilitating.
2. Paul was in a coma after his high-speed car
accident. His physicians were concerned that he
had suffered a (palsy, myelomeningocele,
contusion and subdural hematoma) as a result of
the accident.
3. Dick went to the emergency department
complaining of dizziness, nausea, and headache.
The physician, suspecting increased ICP,
prescribed corticosteroids, and Dick's symptoms
disappeared. They returned, however, when the
steroids were discontinued. A/an (MRI study of
the brain, electroencephalogram, CSF analysis)
revealed a large brain lesion. It was removed
665
surgically and determined to be a/an (embolus,
glioblastoma multiforme, migraine).
4. Dorothy felt weakness in her hand and numbness
in her arm, and noticed blurred vision, all signs of
(herpes zoster, meningitis, TIA). Her physician
requested (myelography, MRA, lumbar puncture)
to assess any damage to cerebral blood vessels and
possible stroke.
5. When Bill noticed ptosis and muscle weakness in
his face, he reported these symptoms to his doctor.
The doctor diagnosed his condition as (Toure e
syndrome, Huntington disease, myasthenia
gravis) and prescribed (dopamine,
anticonvulsants, anticholinesterase drugs), which
relieved his symptoms.
6. To rule out bacterial (epilepsy, encephalomalacia,
meningitis), Dr. Phillips, a pediatrician, requested
that a/an (EEG, PET scan, LP) be performed on the
febrile (feverish) child.
7. Eight-year-old Barry reversed his le ers and had
difficulty learning to read and write words. His
family physician diagnosed his problem as
(aphasia, dyslexia, ataxia).
8. After his head hit the steering wheel during a
recent automobile accident, Clark noticed
(hemiparesis, paraplegia, hyperesthesia) on the
left side of his body. A head CT scan revealed
(narcolepsy, neurasthenia, subdural hematoma).
9. For her 35th birthday, Elizabeth's husband threw
her a surprise party. She was so startled by the
crowd that she experienced a weakness of muscles
and loss of consciousness. Friends placed her on
666
her back in a horizontal position with her head low
to improve blood flow to her brain. She soon
recovered from her (myoneural, syncopal,
hyperkinetic) episode.
10. Near his 65th birthday, Edward began having
difficulty remembering recent events. Over the
next 5 years, he developed (dyslexia, dementia,
seizures) and was diagnosed with (multiple
sclerosis, myasthenia gravis, Alzheimer disease).
11. Elderly Mrs. Smith had been taking an
antipsychotic drug for 5 years when she began
exhibiting lip smacking and darting movements of
her tongue. Her doctor described her condition as
(radiculitis, tardive dyskinesia, hemiparesis) and
discontinued her drug. The condition, acquired
after use of the drug, would be considered
(iatrogenic, congenital, ictal).
O Complete the spelling of the following terms based
on their meanings.
1. part of the brain that controls sleep, appetite,
temperature, and secretions of the pituitary gland:
hypo
_____________________________________________
___
2. pertaining to fainting: syn
_____________________________________________
___
3. abnormal tingling sensations: par
__________________________________________
4. slight paralysis: par
_____________________________________________
667
________
5. inflammation of a spinal nerve root:
_____________________________________________
__ itis
6. inability to speak correctly: a
_____________________________________________
_
7. movements and behavior that are not purposeful: a
______________________________________
8. lack of muscular coordination: a
_____________________________________________
_________
9. developmental reading disorder: dys
_____________________________________________
______
10. excessive movement: hyper
_____________________________________________
_____________
11. paralysis in one half (right or left) of the body:
__________________________________ plegia
12. paralysis in the lower half of the body:
________________________________________
plegia
13. paralysis in all four limbs:
_____________________________________________
_____ plegia
14. nervous exhaustion and fatigue: neur
__________________________________________
668
Answers to Exercises
A
1. axon
2. plexus
3. meninges
4. dendrite
5. cerebral cortex
6. astrocyte
7. oligodendroglial cell
8. neuron
9. cauda equina
10. myelin sheath
B
1. outermost meningeal layer surrounding the brain and
spinal cord
2. brain and the spinal cord
3. nerves outside the brain and spinal cord; cranial,
spinal, and autonomic nerves
4. middle meningeal membrane surrounding the brain
and spinal cord
5. part of the brain below the thalamus; controls sleep,
appetite, body temperature, and secretions from the
pituitary gland
669
6. space through which a nervous impulse is
transmi ed from a nerve cell to another nerve cell or
to a muscle or gland cell
7. autonomic nerves that influence body functions
involuntarily in times of stress
8. part of the brain just above the spinal cord that
controls breathing, heartbeat, and the size of blood
vessels
9. part of the brain anterior to the cerebellum and
between the medulla and the upper parts of the
brain; connects these parts of the brain
10. posterior part of the brain that coordinates
voluntary muscle movements
11. part of the brain below the cerebrum; relay center
that conducts impulses between the spinal cord and
the cerebrum
12. canals in the interior of the brain that are filled with
CSF
13. lower portion of the brain that connects the
cerebrum with the spinal cord (includes the pons and
the medulla)
14. largest part of the brain; controls voluntary muscle
movement, vision, speech, hearing, thought, memory
15. collection of nerve cell bodies outside the brain and
spinal cord
C
1. pia mater
2. motor nerves
670
3. sensory nerves
4. sulci
5. subarachnoid space
6. gyri
7. neurotransmi er
8. parenchymal cell
9. glial cells
D
1. encephalopathy
2. cerebellum
3. epidural hematoma
4. leptomeningitis
5. anencephaly
6. poliomyelitis
7. meningeal
8. radiculopathy
9. myelomeningocele
10. vagal
E
1. outer region of the cerebrum (contains gray ma er)
2. pertaining to within a sheath through the meninges
and into the subarachnoid space
3. inflammation of many nerves
671
4. pertaining to the thalamus
5. disease of the spinal cord
6. tumor of the meninges
7. tumor of neuroglial cells (a brain tumor)
8. mass of blood below the dura mater (outermost
meningeal membrane)
F
1. dyslexia
2. ataxia
3. bradykinesia
4. hyperesthesia
5. narcolepsy
6. aphasia
7. motor apraxia
8. hemiparesis
9. causalgia
10. paraplegia
11. syncope
12. neurasthenia
G
1. lack of sensitivity to pain
2. difficulty in speaking (patient cannot articulate words
but can understand speech and knows what she or he
wants to say)
672
3. weakness and partial loss of movement
4. paralysis in all four extremities (damage is to the
cervical part of the spinal cord)
5. no strength (weakness)
6. pertaining to coma (loss of consciousness from which
the patient cannot be aroused)
7. condition of abnormal sensations (prickling, tingling,
burning)
8. excessive movement
9. condition of no sensation or nervous feeling
10. severe burning pain from injury to peripheral nerves
11. pertaining to without movement
12. diminished sensation to pain
13. impairment of the ability to perform voluntary
movements
14. recurrent vascular headache with severe pain of
unilateral onset and photophobia (sensitivity to light)
H
1. multiple sclerosis
2. epilepsy
3. myelomeningocele
4. amyotrophic lateral sclerosis
5. Huntington disease
6. hydrocephalus
7. myasthenia gravis
673
8. Parkinson disease
9. Alzheimer disease
10. Bell palsy
I
1. tumor of neuroglial brain cells (astrocytes)
2. inflammation of the meninges (bacterial infection
with pus formation)
3. involuntary spasmodic, twitching movements (tics),
uncontrollable vocal sounds, and inappropriate
words
4. bruising of brain tissue as a result of direct trauma to
the head
5. disruption of the normal blood supply to the brain;
stroke or cerebral infarction
6. traumatic brain injury caused by a blow to the head
7. neurologic condition caused by infection with herpes
zoster virus; blisters form along the course of
peripheral nerves
8. blockage of a blood vessel in the cerebrum caused by
material from another part of the body that suddenly
occludes the vessel
9. blockage of a blood vessel in the cerebrum caused by
the formation of a clot within the vessel
10. collection of blood in the brain (can cause a stroke)
11. widening of a blood vessel (artery) in the cerebrum;
the aneurysm can burst and lead to a CVA
674
12. brain disease (dementia and encephalitis) caused by
infection with AIDS virus
J
1. C
2. E
3. H
4. G
5. B
6. A
7. D
8. J
9. I
10. F
K
1. use of magnetic waves to create an image (in frontal,
transverse, or sagi al plane) of the brain
2. an instrument (stereotactic) is fixed onto the skull and
locates a target by three-dimensional measurement;
gamma radiation or proton beams are used to treat
deep brain lesions
L
1. neurasthenia
2. aphasia
3. apraxia
675
4. analgesia
5. anesthesia
6. paresthesia
7. ataxia
8. hyperkinesia
9. dyskinesia
10. dyslexia
11. paresis
M
1. electroencephalography: E
2. positron emission tomography: I
3. alpha-fetoprotein: G
4. multiple sclerosis: J
5. magnetic resonance imaging: H
6. lumbar puncture: C
7. cerebrovascular accident: B
8. Alzheimer disease: A
9. transient ischemic a ack: F
10. cerebrospinal fluid: D
N
1. migraine
2. contusion and subdural hematoma
3. MRI of the brain; glioblastoma multiforme
676
4. TIA; MRA
5. myasthenia gravis; anticholinesterase drugs
6. meningitis; LP
7. dyslexia
8. hemiparesis; subdural hematoma
9. syncopal
10. dementia; Alzheimer disease
11. tardive dyskinesia; iatrogenic
O
1. hypothalamus
2. syncopal
3. paresthesias
4. paresis
5. radiculitis
6. aphasia
7. apraxia
8. ataxia
9. dyslexia
10. hyperkinesis
11. hemiplegia
12. paraplegia
13. quadriplegia
14. neurasthenia
677
Answers to Practical Applications
Case Report: Cerebral Infarction
1. c
2. a
3. c
4. c
5. a
Neuropathic Pain and Case Study
1. d
2. c
3. b
Pronunciation of Terms
The terms you have learned in this chapter are presented here with
their pronunciations. The meanings for all the terms are in the MiniDictionary beginning on page 897. You can also hear each term
pronounced on the Evolve website
(h p://evolve.elsevier.com/Chabner/language/).
Vocabulary and Combining Forms and Terminology
678
TERM
acetylcholine
afferent nerves
akinetic
analgesia
anencephaly
anesthesia
aphasia
apraxia
arachnoid membrane
astrocyte
ataxia
autonomic nervous system
axon
blood-brain barrier
bradykinesia
brainstem
cauda equina
causalgia
cell body
central nervous system
cephalgia
cerebellar
cerebellopontine
cerebellum
cerebral cortex
cerebrospinal fluid
cerebrum
coma
comatose
cranial nerves
dendrite
dura mater
dyskinesia
dyslexia
efferent nerves
encephalitis
encephalopathy
ependymal cell
epidural hematoma
ganglion; pl. ganglia
glial cell
glioblastoma
gyrus; pl. gyri
hemiparesis
hemiplegia
hypalgesia
hyperesthesia
hyperkinesis
hypothalamus
intrathecal injection
leptomeningitis
medulla oblongata
PRONUNCIATION
a-seh-til-KO-leen
AH-fer-ent nervz
a-kih-NET-ik
ah-nal-JE-ze-ah
an-en-SEH-fah-le
an-es-THE-ze-ah
ah-FA-ze-ah
a-PRAK-se-ah
ah-RAK-noyd MEM-brayn
AS-tro-site
a-TAK-se-ah
aw-to-NOM-ik NER-vus SIS-tem
AKS-on
blud-BRAYN BAH-re-er
bra-de-kih-NE-se-ah
BRAYN-stem
KAW-dah eh-KWI-nah
kaw-ZAL-jah
sel BOD-e
SEN-tral NER-vus SIS-tem
seh-FAL-jah
seh-reh-BEL-ar
seh-reh-bel-o-PON-teen
seh-reh-BEL-um
seh-RE-bral KOR-teks
seh-re-bro-SPI-nal FLU-id
seh-RE-brum
KO-mah
KO-mah-tohs
KRA-ne-al nervz
DEN-drite
DUR-ah MAH-ter
dis-kih-NE-ze-ah
dis-LEK-se-ah
EH-fer-ent nervz
en-seh-fah-LI-tis
en-seh-fah-LOP-ah-the
eh-PEN-dih-mal sel
ep-eh-DU-ral he-mah-TO-mah
GANG-le-on; GANG-le-ah
GLE-al sel
gli-o-blah-STO-mah
JI-rus; JI-re
hem-e-pah-RE-sis
hem-e-PLE-jah
hi-pal-GE-ze-ah
hi-per-es-THE-ze-ah
hi-per-kih-NE-sis
hi-po-THAL-ah-mus
in-trah-THE-kal in-JEK-shun
lep-to-men-in-JE-al
meh-DUL-ah ob-lon-GAH-tah
679
TERM
meningeal
meninges
meningioma
microglial cell
midbrain
motor nerve
myelin sheath
myelomeningocele
myelopathy
myoneural
narcolepsy
nerve
neuralgia
neurasthenia
neuroglial cells
neuron
neuropathy
neurotransmi er
oligodendroglial cell
paraplegia
parasympathetic nerves
parenchyma
paresis
paresthesia
peripheral nervous system
pia mater
plexus
poliomyelitis
polyneuritis
pons
quadriplegia
radiculitis
radiculopathy
receptor
sciatic nerve
sciatica
sensory nerve
spinal nerves
stimulus
stroma
subdural hematoma
sulcus; pl. sulci
sympathetic nerves
synapse
syncopal
syncope
thalamic
thalamus
trigeminal neuralgia
vagal
vagus nerve
ventricles of the brain
PRONUNCIATION
meh-NIN-je-al
meh-NIN-jeez
meh-nin-je-O-mah
mi-kro-GLE-al sel
MID-brayn
MO-ter nerv
MI-eh-lin sheeth
mi-eh-lo-meh-NIN-jo-seel
mi-el-OP-ah-the
mi-o-NUR-al
NAR-ko-lep-se
nerv
nu-RAL-jah
nu-ras-THE-ne-ah
nu-ro-GLE-al selz
NU-ron
nu-ROP-ah-the
nu-ro-TRANZ-mit-er
ol-ih-go-den-dro-GLE-al sel
par-ah-PLE-jah
par-ah-sim-pah-THET-ik nervz
pah-REN-kih-mah
pah-RE-sis
pah-res-THE-ze-ah
peh-RIF-er-al NER-vus SIS-tem
PE-ah MAH-ter
PLEK-sus
po-le-o-mi-eh-LI-tis
pol-e-nu-RI-tis
ponz
kwod-rih-PLE-jah
rah-dik-u-LI-tis
rah-dik-u-LOP-ah-the
re-SEPT-or
si-AH-tik nerv
si-AH-tih-kah
SEN-sor-e nerv
SPI-nal nervz
STIM-u-lus
STRO-mah
sub-DU-ral he-mah-TO-mah
SUL-kus; SUL-si
sim-pah-THET-ik nervz
SIN-aps
SIN-ko-pal
SIN-ko-pe
THAL-ah-mik
THAL-ah-mus
tri-JEM-in-al nu-RAL-jah
VA-gal
VA-gus nerv
VEN-trih-kulz of the brayn
680
Pathology, Laboratory Tests, and Clinical Procedures
681
TERM
absence seizure
Alzheimer disease
amyotrophic lateral sclerosis
aneurysm
astrocytoma
aura
Bell palsy
brain tumor
cerebral angiography
cerebral concussion
cerebral contusion
cerebral hemorrhage
cerebral palsy
cerebrospinal fluid analysis
cerebrovascular accident
computed tomography
dementia
demyelination
dopamine
doppler/ultrasound studies
electroencephalography
embolus
epilepsy
gait
glioblastoma
herpes zoster
HIV encephalopathy
Huntington disease
hydrocephalus
ictal event
lumbar puncture
magnetic resonance imaging
meningitis
meningocele
migraine
multiple sclerosis
myasthenia gravis
occlusion
palliative
palsy
Parkinson disease
positron emission tomography
shingles
spina bifida
stereotactic radiosurgery
thrombus
tic
tonic-clonic seizure
Toure e syndrome
transient ischemic a ack
PRONUNCIATION
AB-sens SE-zhur
ALZ-hi-mer dih-ZEEZ
a-mi-o-TRO-fik LAH-ter-al skleh-RO-sis
AN-ur-ih-zim
as-tro-si-TO-mah
AW-rah
bel PAWL-ze
BRAYN TU-mor
seh-RE-bral an-je-OG-rah-fe
seh-RE-bral kon-KUH-shun
seh-RE-bral kon-TU-shun
seh-RE-bral HEM-or-ij
seh-RE-bral PAWL-ze
seh-re-bro-SPI-nal FLU-id ah-NAH-lih-sis
seh-re-bro-VAS-cu-lar AK-sih-dent
kom-PU-ted to-MOG-rah-fe
de-MEN-she-ah
de-mi-eh-lih-NA-shun
DO-pah-meen
DOP-ler / UL-trah-sound STUD-eez
eh-lek-tro-en-sef-al-OG-rah-fe
EM-bo-lus
EP-ih-lep-se
gate
gle-o-blah-STO-mah
HER-peez ZOS-ter
HIV en-seh-fal-OP-ah-the
HUN-ting-ton dih-ZEEZ
hi-dro-SEH-fah-lus
IK-tal e-VENT
LUM-bar PUNK-shur
mag-NET-ik REH-zo-nants IM-aj-ing
meh-nin-JI-tis
meh-NIN-jo-seel
MI-grane
MUL-tih-pel skleh-RO-sis
mi-as-THE-ne-ah GRAV-is
o-KLU-zhun
PAH-le-ah-tiv
PAWL-ze
PAR-kin-sun dih-ZEEZ
POS-ih-tron e-MIH-shun to-MOG-rah-fe
SHING-ulz
SPI-na BIF-ih-dah
steh-re-o-TAK-tik ra-de-o-SUR-jer-e
THROM-bus
TIK
TON-ik-KLON-ik SE-zhur
tur-ET SIN-drohm
TRAN-ze-ent ih-SKE-mik ah-TAK
682
Review Sheet
Write the meanings of the word parts in the spaces provided. Check
your answers with the information in the chapter or in the Glossary
(Medical Word Parts—English) at the end of the book.
Combining Forms
COMBINING FORM
alges/o
angi/o
caus/o
cephal/o
cerebell/o
cerebr/o
comat/o
crani/o
cry/o
dur/o
encephal/o
esthesi/o
gli/o
hydr/o
kines/o, kinesi/o
lept/o
lex/o
mening/o, meningi/o
my/o
myel/o
narc/o
neur/o
olig/o
pont/o
radicul/o
spin/o
syncop/o
tax/o
thalam/o
thec/o
troph/o
vag/o
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Prefixes
683
PREFIX
a-, andysepihemihyperhypointramicroparapoliopolyquadrisub-
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Suffixes
SUFFIX
-algesia
-algia
-blast
-cele
-esthesia
-gram
-graphy
-ine
-itis
-kinesia, -kinesis
-kinetic
-lepsy
-oma
-ose
-paresis
-pathy
-phagia
-phasia
-plegia
-praxia
-ptosis
-sclerosis
-sthenia
-tomy
-trophy
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Match the neurologic pathology terms and abbreviations in Column I
with the descriptions/definitions in Column II.
684
COLUMN I
1. Alzheimer's
2. ALS
3. epilepsy
4. MS
5. Parkinson's
6. herpes zoster
7. glioblastoma
multiforme
______
______
______
______
______
______
______
8. CVA
______
COLUMN II
A. destruction of myelin sheath on neurons in CNS
B. stroke; disruption in normal blood supply to the brain
C. shingles; viral infection affecting peripheral nerves
D. progressive dementia; memory failure; senile plaques and
neurofibrillary tangles
E. brain tumor; malignant astrocytoma
F. degeneration of neurons in basal ganglia; tremors,
bradykinesia, and shuffling gait
G. recurrent seizure disorder; tonic-clonic and absence types
H. degeneration of motor neurons in spinal cord and brain
stem; weakness and muscle atrophy
Books with Neurologic Topics
The following list of books may be of interest to you. They deal with
fictional characters or actual individuals who are coping with
neurologic illnesses. Oliver Sacks, M.D., the late professor of neurology
at the NYU School of Medicine, has wri en extensively about
neurological case histories, including The Man Who Mistook his Wife for a
Hat. Please contact me with your comments and other suggestions of
good reads!
685
Alzheimer Disease
Still Alice by Lisa Genova (story of a woman and her family understanding and coping
with early-onset Alzheimer's; also made into a film).
Elegy for Iris by John Bayley (story of novelist Iris Murdoch; wri en by her husband, who
becomes her caretaker).
Amyotrophic Lateral Sclerosis
I Choose to Live: A Journey Through Life with ALS by William Sinton (a story of coping with
this disease).
Tuesdays with Morrie by Mitch Albom (wri en by a student who spends time with his
former teacher and learns valuable life lessons).
Cerebral Palsy
My Left Foot by Christy Brown (Brown was born in Dublin with cerebral palsy, and this is
his autobiography, which was later made into a film).
Epilepsy
The Spirit Catches You and You Fall Down by Anne Fadiman (story of the Hmong people and
how they deal with epilepsy after coming to the United States).
The Spiral Staircase: My Climb out of Darkness by Karen Armstrong (how author Karen
Armstrong deals with temporal lobe epilepsy).
The Idiot by Fyodor Dostoevsky (Russian novel whose main character, Prince Myshkin, like
Dostoevsky himself, suffers from epilepsy).
Huntington Disease
Saturday by Ian McEwan (a novel whose primary character suffers from this disease).
Parkinson Disease
Life in the Balance by Thomas Graboys with Peter Zheutlin (memoir of Graboys, a
prominent Boston cardiologist dealing with this disease).
Stroke
My Stroke of Insight by Jill Brotle Taylor, PhD (a brain scientist, who had a stroke at age 37,
writes about it).
The Diving Bell and the Bu erfly, by Jean-Dominque Bauby, is a memoir by a 44-year-old
man who struggles with the consequences of a rare type of stroke that leaves him
quadriplegic. His mind is unimpaired (also made into a film).
686
C H A P T E R 11
687
Cardiovascular System
CHAPTER SECTIONS:
Introduction 374
Blood Vessels and the Circulation of Blood 374
Anatomy of the Heart 378
Physiology of the Heart 381
Blood Pressure 382
Vocabulary 384
Terminology 385
Pathology: The Heart and Blood Vessels 388
Laboratory Tests and Clinical Procedures 401
Abbreviations 408
Practical Applications 410
In Person: Coronary Artery Bypass Surgery 412
Exercises 413
Answers to Exercises 422
Pronunciation of Terms425
Review Sheet 429
CHAPTER GOALS
• Name the parts of the heart and associated blood vessels and their
functions in the circulation of blood.
• Trace the pathway of blood through the heart.
• Identify and describe major pathologic conditions affecting the heart and
blood vessels.
• Define combining forms that relate to the cardiovascular system.
688
• Describe important laboratory tests and clinical procedures pertaining to
the cardiovascular system, and recognize relevant abbreviations.
• Apply your new knowledge to understand medical terms in their proper
context, such as in medical reports and records.
689
Introduction
Body cells are dependent on a constant supply of nutrients and oxygen.
When the supplies are delivered and then chemically combined, they
release the energy necessary to do the work of each cell. How does the
body ensure that oxygen and food will be delivered to all of its cells?
The cardiovascular system, consisting of the heart (a powerful muscular
pump) and blood vessels (fuel line and transportation network),
performs this important work. This chapter explores terminology
related to the heart and blood vessels.
690
Blood Vessels and the Circulation of
Blood
Blood Vessels
There are three types of blood vessels in the body: arteries, veins, and
capillaries.
Arteries are large blood vessels that carry blood away from the heart.
Their walls are lined with connective tissue, muscle tissue, and elastic
fibers, with an innermost layer of epithelial cells called endothelium.
Endothelial cells, found in all blood vessels, secrete factors that affect
the size of blood vessels, reduce blood clo ing, and promote the growth
of blood vessels. Because arteries carry blood away from the heart, they
must be strong enough to withstand the high pressure of the pumping
action of the heart. Their elastic walls allow them to expand as the
heartbeat forces blood into the arterial system throughout the body.
Smaller branches of arteries are arterioles. Arterioles are thinner than
arteries and carry the blood to the tiniest of blood vessels, the
capillaries.
Capillaries have walls that are only one endothelial cell in thickness.
These delicate, microscopic vessels carry nutrient-rich, oxygenated
blood from the arteries and arterioles to the body cells. Their thin walls
allow passage of oxygen and nutrients out of the bloodstream and into
cells. There, the nutrients are burned in the presence of oxygen
(catabolism) to release energy. At the same time, waste products such as
carbon dioxide and water pass out of cells and into the thin-walled
capillaries. Waste-filled blood then flows back to the heart in small
venules, which combine to form larger vessels called veins.
Veins have thinner walls compared with arteries. They conduct blood
(that has given up most of its oxygen) toward the heart from the tissues.
Veins have li le elastic tissue and less connective tissue than that typical
of arteries, and blood pressure in veins is extremely low compared with
pressure in arteries. In order to keep blood moving back toward the
heart, veins have valves that prevent the backflow of blood and keep
the blood moving in one direction. Muscular action also helps the
movement of blood in veins. Figure 11-1 illustrates the differences in
blood vessels. Figure 11-2 reviews their characteristics and relationship
to one another.
691
FIGURE 11-1 Blood vessels. Observe the differences in
thickness of walls among an artery, a vein, and a capillary. All
three vessels are lined with endothelium. Endothelial cells
actively secrete substances that prevent clotting and regulate the
tone of blood vessels. Examples of endothelial secretions are
endothelium-derived relaxing factor (EDRF) and endothelin (a
vasoconstrictor).
692
FIGURE 11-2 Relationship and characteristics of blood vessels.
Blood Vessels and Blood
What color is blood? Blood is bright red in arteries (contains oxygen)
and dark red (maroon) in veins (contains carbon dioxide). From the
outside of the body, blood in veins appears blue because the color
reflects off the skin.
How much blood is in the body? The average adult has about 5
quarts (4.7 liters) of blood in his or her body.
What is the length of all the blood vessels? The total length of all
the blood vessels in the body is 60,000 miles!
Circulation of Blood
Arteries, arterioles, veins, venules, and capillaries, together with the
heart, form a circulatory system for the flow of blood. Figure 11-3 is a
more detailed representation of the entire circulatory system. Refer to it
as you read the following paragraphs. (Note that the bracketed numbers
in the following paragraphs correspond with those in Figure 11-3.)
693
FIGURE 11-3 Schematic diagram of the pulmonary circulation
(blood flow from the heart to lung capillaries and back to the
heart) and systemic circulation (blood flow from the heart to
tissue capillaries and back to the heart).
Blood that is deficient in oxygen flows through two large veins, the
venae cavae [1], on its way from the tissue capillaries to the heart. The
blood became oxygen-poor at the tissue capillaries when oxygen left the
blood and entered the body cells.
Oxygen-poor blood enters the right side of the heart [2] and travels
through that side and into the pulmonary artery [3], a vessel that
divides in two: one branch leading to the left lung, the other to the right
lung. The arteries continue dividing and subdividing within the lungs,
forming smaller and smaller vessels (arterioles) and finally reaching the
lung capillaries [4]. The pulmonary artery is unusual in that it is the
only artery in the body that carries blood deficient in oxygen.
While passing through the lung (pulmonary) capillaries, blood
absorbs the oxygen that entered the body during inhalation. The newly
oxygenated blood next returns immediately to the heart through
694
yg
y
g
pulmonary veins [5]. The pulmonary veins are unusual in that they are
the only veins in the body that carry oxygen-rich (oxygenated) blood.
The circulation of blood through the vessels from the heart to the lungs
and then back to the heart again is the pulmonary circulation.
Oxygen-rich blood enters the left side of the heart [6] from the
pulmonary veins. The muscles in the left side of the heart pump the
blood out of the heart through the largest single artery in the body, the
aorta [7]. The aorta moves up at first (ascending aorta) but then arches
over dorsally and runs downward (descending aorta) just in front of the
vertebral column. The aorta divides into numerous branches called
arteries [8] that carry the oxygenated blood to all parts of the body. The
names of some of these arterial branches will be familiar to you. The
carotid arteries supply blood to the head and neck. Axillary, brachial
(brachi/o means arm), splenic and renal arteries are examples of
branching arteries from the aorta.
The relatively large arterial vessels branch further to form smaller
arterioles [9]. The arterioles, still containing oxygenated blood, branch
into smaller tissue capillaries [10], which are near the body cells.
Oxygen leaves the blood and passes through the thin capillary walls to
enter the body cells. There, food is broken down, in the presence of
oxygen, and energy is released.
This chemical process also releases carbon dioxide (CO2) as a waste
product. Carbon dioxide passes out from the cell into the tissue
capillaries at the same time that oxygen enters. Thus the blood
returning to the heart from tissue capillaries through venules [11] and
veins [12] is filled with carbon dioxide but is depleted of oxygen.
As this oxygen-poor blood enters the heart from the venae cavae, the
circuit is complete. The pathway of blood from the heart to the tissue
capillaries and back to the heart is the systemic circulation.
Figure 11-4 shows the aorta, selected arteries, and pulse points. The
pulse is the beat of the heart as felt through the walls of arteries.
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FIGURE 11-4 The aorta and arteries. Solid gold dots indicate
pulse points in arteries. These are areas in which the pulse
expansion and contraction of a superficial artery can be felt.
696
Anatomy of the Heart
The human heart weighs less than a pound (300-450 grams), is roughly
the size of an adult fist, and lies in the thoracic cavity, just behind the
breastbone in the mediastinum (between the lungs).
The heart is a pump consisting of four chambers: two upper chambers
called atria (singular: atrium) and two lower chambers called ventricles.
It is actually a double pump, bound into one organ and synchronized
very carefully. Blood passes through each pump in a definite pa ern.
Pump station number one, on the right side of the heart, sends oxygendeficient blood to the lungs, where the blood picks up oxygen and
releases its carbon dioxide. The newly oxygenated blood returns to the
left side of the heart to pump station number two and does not mix with
the oxygen-poor blood in pump station number one. Pump station
number two then forces the oxygenated blood out to all parts of the
body. At the body tissues, the blood loses its oxygen, and on returning
to the heart, to pump station number one, blood poor in oxygen (rich in
carbon dioxide) is sent out to the lungs to begin the cycle anew.
Label Figure 11-5 as you learn the names of the parts of the heart and
the vessels that carry blood to and from it.
697
FIGURE 11-5 Structure of the heart. Blue arrows indicate
oxygen-poor blood flow. Red arrows show oxygenated blood
flow.
Oxygen-poor blood enters the heart through the two largest veins in
the body, the venae cavae. The superior vena cava [1] drains blood from
the upper portion of the body, and the inferior vena cava [2] carries
blood from the lower part of the body.
The venae cavae bring oxygen-poor blood that has passed through all
of the body to the right atrium [3], the thin-walled upper right chamber
of the heart. The right atrium contracts to force blood through the
tricuspid valve [4] (cusps are the flaps of the valves) into the right
ventricle [5], the lower right chamber of the heart. The cusps of the
tricuspid valve form a one-way passage designed to keep the blood
flowing in only one direction. As the right ventricle contracts to pump
698
oxygen-poor blood through the pulmonary valve [6] into the
pulmonary artery [7], the tricuspid valve stays shut, thus preventing
blood from pushing back into the right atrium. The pulmonary artery
then branches to carry oxygen-deficient blood to each lung.
The blood that enters the lung capillaries from the pulmonary artery
soon loses its large quantity of carbon dioxide into the lung tissue, and
the carbon dioxide is expelled. At the same time, oxygen enters the
capillaries of the lungs and is brought back to the heart via the
pulmonary veins [8]. The newly oxygenated blood enters the left
atrium [9] of the heart from the pulmonary veins. The walls of the left
atrium contract to force blood through the mitral valve [10] into the left
ventricle [11].
The left ventricle has the thickest walls of all four heart chambers
(three times the thickness of the right ventricular wall). It must pump
blood with great force so that the blood travels through arteries to all
parts of the body. The left ventricle propels the blood through the aortic
valve [12] into the aorta [13], which branches to carry blood all over the
body. The aortic valve closes to prevent return of aortic blood to the left
ventricle.
In Figure 11-6, notice that the four chambers of the heart are
separated by partitions called septa (singular: septum). (Label Figure 116 as you read these paragraphs.) The interatrial septum [1] separates
the two upper chambers (atria), and the interventricular septum [2], a
muscular wall, lies between the two lower chambers (ventricles).
699
FIGURE 11-6 The septa (walls of the heart) and the 3 layers
of the heart. Note that the apex of the heart is the conical
(shaped like a cone) lower tip of the heart.
Figure 11-6 also shows the three layers of the heart. The endocardium
[3], a smooth layer of endothelial cells, lines the interior of the heart and
heart valves. The myocardium [4], the middle, muscular layer of the
heart wall, is its thickest layer. The pericardium [5], a fibrous and
membranous sac, surrounds the heart. It is composed of two layers, the
visceral pericardium, adhering to the heart, and the parietal (parietal
means wall) pericardium, lining the outer fibrous coat. The pericardial
cavity (between the visceral and the parietal pericardial layers)
normally contains 10 to 15 mL of pericardial fluid, which lubricates the
membranes as the heart beats.
Figure 11-7 reviews the pathway of blood through the heart.
700
FIGURE 11-7 Pathway of blood through the heart.
701
Physiology of the Heart
Heartbeat and Heart Sounds
There are two phases of the heartbeat: diastole (relaxation) and systole
(contraction). Diastole occurs when the ventricle walls relax and blood
flows into the heart from the venae cavae and the pulmonary veins. The
tricuspid and mitral valves open in diastole, as blood passes from the
right and left atria into the ventricles. The pulmonary and aortic valves
close at beginning of diastole. (Figure 11-8).
FIGURE 11-8 Phases of the heartbeat: diastole and systole.
During diastole, the tricuspid and mitral valves are open as blood
enters the ventricles. During systole, the pulmonary and aortic
valves are open as blood is pumped to the pulmonary artery and
aorta. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right
ventricle.
Systole occurs next, as the walls of the right and left ventricles
contract to pump blood into the pulmonary artery and the aorta. Both
the tricuspid and the mitral valves are closed during systole, thus
preventing the flow of blood back into the atria (see Figure 11-8).
This diastole-systole cardiac cycle occurs between 70 and 80 times per
minute (100,000 times a day). The heart pumps about 3 ounces of blood
with each contraction. This means that about 5 quarts of blood are
pumped by the heart in 1 minute (75 gallons an hour and about 2000
gallons a day).
Closure of the heart valves is associated with audible sounds, such as
“lubb-dubb,” which can be heard on listening to a normal heart with a
702
stethoscope. The “lubb” is associated with closure of the tricuspid and
mitral valves at the beginning of systole, and the “dubb” with the
closure of the aortic and pulmonary valves at the end of systole. The
“lubb” sound is called the first heart sound (S1) and the “dubb” is the
second heart sound (S2), because the normal cycle of the heartbeat starts
with the beginning of systole. Sometimes the flow of blood through the
valves can produce an abnormal swishing sound known as a murmur.
Conduction System of the Heart
What keeps the heart at its perfect rhythm? Although the heart has
nerves that affect its rate, they are not primarily responsible for its beat.
The heart starts beating in the embryo before it is supplied with nerves,
and continues to beat in experimental animals even when the nerve
supply is cut.
Label Figure 11-9 as you read the following. Primary responsibility
for initiating the heartbeat rests with a small region of specialized
muscle tissue in the posterior portion of the right atrium, where an
electrical impulse originates. This is the sinoatrial node (SA node), or
pacemaker [1] of the heart. The current of electricity generated by the
pacemaker causes the walls of the atria to contract and force blood into
the ventricles.
FIGURE 11-9 Conduction system of the heart.
703
Almost like ripples in a pond of water when a stone is thrown, the
wave of electricity passes from the pacemaker to another region of the
myocardium. This region is within the interatrial septum and is the
atrioventricular node (AV node) [2]. The AV node immediately sends
the excitation wave to a bundle of specialized muscle fibers called the
atrioventricular bundle, or bundle of His [3]. Within the
interventricular septum, the bundle of His divides into the left bundle
branch [4] and the right bundle branch [5], which form the conduction
myofibers that extend through the ventricle walls and contract on
stimulation. Thus systole occurs and blood is pumped away from the
heart. A short rest period follows, and then the pacemaker begins the
wave of excitation across the heart again.
The record used to detect these electrical changes in heart muscle as
the heart beats is an electrocardiogram (ECG or EKG). The normal ECG
tracing shows five waves, or deflections, that represent the electrical
changes as a wave of excitation spreads through the heart. The
deflections are called P, QRS, and T waves. Figure 11-10 illustrates P,
QRS, and T waves on a normal ECG tracing.
FIGURE 11-10 Electrocardiogram. P wave = spread of
excitation wave over the atria just before contraction; QRS wave
= spread of excitation wave over the ventricles as the ventricles
contract; T wave = electrical recovery and relaxation of
ventricles. A heart attack or myocardial infarction (MI) can be
recognized by an elevation in the ST segment of the
electrocardiographic tracing. Thus, one type of MI is an ST
elevation MI (STEMI).
Heart rhythm (originating in the SA node and traveling through the
heart) is called normal sinus rhythm (NSR). Sympathetic nerves speed
704
up the heart rate during conditions of emotional stress or vigorous
exercise. Parasympathetic nerves slow the heart rate when there is no
need for extra pumping.
705
Blood Pressure
Blood pressure is the force that the blood exerts on the arterial walls.
This pressure is measured with a sphygmomanometer (Figure 11-11).
FIGURE 11-11 Measurement of blood pressure with a
sphygmomanometer and stethoscope.
The sphygmomanometer consists of a rubber bag inside a cloth cuff
that is wrapped around the upper arm, just above the elbow. The
rubber bag is inflated with air using a handbulb pump. As the bag is
pumped up, the pressure within it increases and is measured on a
recording device a ached to the cuff.
The brachial artery in the upper arm is compressed by the air
pressure in the bag. When there is sufficient air pressure in the bag to
stop the flow of blood, the pulse in the lower arm (where the observer is
listening with a stethoscope) drops.
Air is then allowed to escape from the bag and the pressure is
lowered slowly, allowing the blood to begin to make its way through
the gradually opening artery. At the point when the person listening
with the stethoscope first hears the sounds of the pulse beats, the
reading on the device a ached to the cuff shows the higher, systolic
blood pressure (pressure in the artery when the left ventricle is
contracting to force the blood into the aorta and other arteries).
As air continues to escape, the sounds become progressively louder.
Finally, when a change in sound from loud to soft occurs, the observer
makes note of the pressure on the recording device. This is the diastolic
706
pressure (pressure in the artery when the ventricles relax and the heart
fills, receiving blood from the venae cavae and pulmonary veins).
Blood pressure is expressed as a fraction—for example, 120/80 mm
Hg, in which the upper number (120) is the systolic pressure and the
lower number (80) is the diastolic pressure. A new guideline lowers the
target for hypertension (high blood pressure) treatment to 130/80. Both
the systolic and diastolic components of hypertension are associated
with increased risk of heart a ack and stroke.
Vocabulary
This list reviews new terms introduced in the text. Short definitions
reinforce your understanding of the terms. See page 425 of this chapter
for pronunciation of terms.
707
aorta
apex of the heart
arteriole
artery
Largest artery in the body.
Lower tip of the heart.
Small artery.
Largest type of blood vessel; carries blood away from the heart to all
parts of the body. Notice that artery and away begin with an “a.”
atrioventricular
Specialized muscle fibers connecting the atria with the ventricles and
bundle (bundle of
transmi ing electrical impulses between them. His is pronounced
His)
“hiss.”
atrioventricular
Specialized tissue in the wall between the atria. Electrical impulses
node (AV node)
pass from the pacemaker (SA node) through the AV node and the
atrioventricular bundle or bundle of His toward the ventricles.
atrium (plural: atria) One of two upper chambers of the heart.
capillary
Smallest type of blood vessel. Materials pass to and from the
bloodstream through the thin capillary walls.
carbon dioxide
Gas (waste) released by body cells, transported via veins to the heart,
(CO2)
and then to the lungs for exhalation.
carotid arteries
Two common carotid arteries located on each side of the neck branch
from the aorta and provide blood to head, neck and brain. The word
carotid comes from a Greek word meaning stupor because pressure
on these arteries produced unconsciousness.
coronary arteries
Blood vessels that branch from the aorta and carry oxygen-rich blood
to the heart muscle.
deoxygenated blood Blood that is oxygen-poor.
diastole
Relaxation phase of the heartbeat. (From Greek diastole, dilation.)
electrocardiogram
Record of the electrical activity of the heart. The electricity is
represented by waves or deflections called P, QRS, or T.
endocardium
Inner lining of the heart.
endothelium
Innermost lining of blood vessels.
mitral valve
Valve between the left atrium and the left ventricle; bicuspid valve.
murmur
Abnormal swishing sound caused by improper closure of the heart
valves.
myocardium
Muscular middle layer of the heart.
normal sinus
Heart rhythm originating in the sinoatrial node with a rate in
rhythm
patients at rest of 60 to 100 beats per minute.
oxygen
Gas that enters the blood through the lungs and travels to the heart
to be pumped via arteries to all body cells.
pacemaker
Specialized nervous tissue in the right atrium that begins the
(sinoatrial node)
heartbeat. An artificial cardiac pacemaker is an electronic apparatus
implanted in the chest to stimulate heart muscle that is weak and not
functioning.
pericardium
Double-layered membrane surrounding the heart.
pulmonary artery
Artery carrying oxygen-poor blood from the heart to the lungs.
pulmonary
Flow of blood from the heart to the lungs and back to the heart.
circulation
pulmonary valve
Valve positioned between the right ventricle and the pulmonary
artery.
pulmonary vein
One of two pairs of vessels carrying oxygenated blood from the
lungs to the left atrium of the heart.
pulse
Beat of the heart as felt through the walls of the arteries.
septum (plural:
Partition or wall dividing a cavity; such as between the right and left
septa)
atria (interatrial septum) and right and left ventricles
(interventricular septum).
sinoatrial node (SA Pacemaker of the heart.
node)
708
sphygmomanometer Instrument to measure blood pressure.
systemic circulation Flow of blood from body tissue to the heart and then from the heart
back to body tissues.
systole
Contraction phase of the heartbeat. (From Greek systole, contraction.)
tricuspid valve
Located between the right atrium and the right ventricle; it has three
(tri-) leaflets, or cusps.
valve
Structure in veins or in the heart that temporarily closes an opening
so that blood flows in only one direction.
vein
Thin-walled vessel that carries blood from body tissues and lungs
back to the heart. Veins contain valves to prevent backflow of blood.
vena cava (plural:
Largest vein in the body. The superior and inferior venae cavae
venae cavae)
return blood to the right atrium of the heart.
ventricle
One of two lower chambers of the heart.
venule
Small vein.
Terminology
Write the meaning of the medical term in the space provided.
709
COMBINING
MEANING TERMINOLOGY
MEANING
FORM
angi/o
vessel
angiogram _____________________________________
angioplasty ____________________________________
aort/o
aorta
aortic stenosis __________________________________
arter/o,
artery
arteriosclerosis _________________________________
arteri/o
arterial anastomosis _____________________________
From the Greek anastomoien, providing a mouth.
arteriography ___________________________________
endarterectomy __________________________________
See page 407.
ather/o
yellowish
atheroma _______________________________________
plaque, fa y
The suffix -oma means mass or collection. Atheromas are
substance
collections of plaque that protrude into the lumen (opening) of
(Greek
an artery, weakening the muscle lining.
athere means
atherosclerosis ___________________________________
porridge)
The major form of arteriosclerosis in which deposits of yellow
plaque (atheromas) containing cholesterol and lipids are found
within the lining of the artery (Figure 11-12).
atherectomy _____________________________________
atri/o
atrium,
atrial _________________________________________
upper heart
atrioventricular
chamber
_________________________________________
brachi/o
arm
brachial artery _________________________________________
cardi/o
heart
cardiomegaly ___________________________________
cardiomyopathy _________________________________
One type of cardiomyopathy is hypertrophic
cardiomyopathy—abnormal thickening of heart muscle,
usually in the left ventricle. The ventricle has to work harder to
pump blood. The condition may be inherited or develop over
time because of high blood pressure or aging. Often the cause is
unknown (idiopathic).
bradycardia _____________________________________
Slower than 60 beats per minute. Normal pulse is about 60100 beats per minute. Brady- means slow.
tachycardia _____________________________________
Faster than 100 beats per minute. Supraventricular
tachycardia (SVT) involves rapid beats coming from the atria
(above the ventricles) and causing palpitation (abnormal
sensations in the chest). Tachy- means fast.
cardiogenic shock ________________________________
Results from failure of the heart in its pumping action. Shock
is circulatory failure associated with inadequate delivery of
oxygen and nutrients to body tissues.
cholesterol/o cholesterol
hypercholesterolemia _____________________________
(a lipid
Statins are drugs that work by blocking a key enzyme in the
substance)
production of cholesterol by the liver.
coron/o
heart
coronary arteries _________________________________
These arteries come down over the top of the heart like a crown
(corona); see Figure 11-23A, page 402.
cyan/o
blue
cyanosis _______________________________________
This bluish discoloration of the skin indicates diminished
oxygen content of the blood.
710
COMBINING
MEANING TERMINOLOGY
MEANING
FORM
myx/o
mucus
myxoma _______________________________________
A benign tumor derived from connective tissue, with cells
embedded in soft mucoid stromal tissue. These rare tumors
occur most frequently in the left atrium.
ox/o
oxygen
hypoxia ________________________________________
Inadequate oxygen in tissues. Anoxia is an extreme form of
hypoxia.
pericardi/o
pericardium
pericardiocentesis ________________________________
Removal of excess fluid from the pericardial space.
phleb/o
vein
phlebotomy _____________________________________
A phlebotomist is trained in opening veins for phlebotomy.
thrombophlebitis ________________________________
Often shortened to phlebitis. If the affected vein is deep within
a muscle, the condition is deep vein thrombosis (DVT).
rrhythm/o
rhythm
arrhythmia _____________________________________
Dysrhythmia is also used to describe an abnormal heart
rhythm. Notice that one “r” is dropped.
sphygm/o
pulse
sphygmomanometer ______________________________
A sphygmomanometer measures pressure.
steth/o
chest
stethoscope _____________________________________
A misnomer because the examination is by ear, not by eye.
Auscultation means listening to sounds within the body,
typically using a stethoscope.
thromb/o
clot
thrombolysis ____________________________________
valvul/o,
valve
valvuloplasty ____________________________________
valv/o
A balloon-tipped catheter dilates a cardiac valve.
mitral valvulitis __________________________________
Commonly associated with rheumatic fever, an inflammatory
disease caused by inadequate treatment of a streptococcal
infection. An autoimmune reaction occurs, leading to
inflammation and damage to heart valves. (See Figure 11-19,
page 396.)
valvotomy ______________________________________
vas/o
vessel
vasoconstriction _________________________________
Constriction means to tighten or narrow.
vasodilation _____________________________________
vascul/o
vessel
vascular ________________________________________
ven/o, ven/i
vein
venous _________________________________________
A venous cutdown is a small surgical incision to permit access
to a collapsed vein. An intravenous infusion is delivery of
fluids into a vein.
venipuncture ___________________________________
This procedure is performed for phlebotomy or to start an
intravenous infusion.
ventricul/o
ventricle,
interventricular septum ____________________________
lower heart
chamber
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FIGURE 11-12 Atherosclerosis. Arrow points to accumulated
plaque in lumen of an artery. (Courtesy Sid Murphree, MD,
Department of Pathology, University of Texas Southwestern Medical
School, Dallas, Texas.)
ather/o, arteri/o, arthr/o
These three combining forms are easily confused.
ather/o = yellowish plaque
arteri/o = artery
arthr/o = joint
712
Pathology: the Heart and Blood Vessels
Heart
713
arrhythmias
Abnormal heart rhythms (dysrhythmias).
Arrhythmias are problems with the conduction or electrical system
of the heart. More than 4 million Americans have recurrent cardiac
arrhythmias.
Examples of cardiac arrhythmias are:
1. bradycardia and
Failure of proper conduction of impulses from the SA node
heart block
through the AV node to the atrioventricular bundle (bundle of
(atrioventricular
His).
block)
Damage to the SA node may cause its impulses to be too weak to
activate the AV node and impulses fail to reach the ventricles. The
heart beats slowly and bradycardia results. If the failure occurs
only occasionally, the heart misses a beat in a rhythm at regular
intervals (partial heart block). If no impulses reach the AV node
from the SA node, the ventricles contract slower than the atria and
are not coordinated. This is complete heart block.
Right and left bundle branch block (RBBB and LBBB) are common
types of heart block. They involve delay or failure of impulses
traveling through the right and left bundle branches to the
ventricles.
Implantation of an artificial cardiac pacemaker overcomes arrhythmias
and keeps the heart beating at the proper rate. The pacemaker power
source is a generator that contains a computer and lithium ba ery. It is
implanted under the skin just below the collarbone, with leads (wires)
to both chambers or one chamber, on the right side of the heart. A
newer type of pacemaker, called a biventricular pacemaker, treats
delays and abnormalities in ventricular contractions (dysynergy) and
also can relieve symptoms and improve quality of life in patients with
congestive heart failure. It reduces exacerbations of heart failure that
require hospital admission (Figure 11-13C).
2. flu er
Rapid but regular contractions, usually of the atria.
Heart rate may reach up to 300 beats per minute. Atrial flu er often
is symptomatic of heart disease and frequently requires treatment
such as medication, electrical cardioversion, or catheter ablation
(see below under fibrillation).
3. fibrillation
Very rapid, random, inefficient, and irregular contractions of the
heart (350 beats or more per minute).
Atrial fibrillation (AF) is the most common type of cardiac
arrhythmia, affecting 5% to 10% of 70- to 80-year-old people and
greater than 15% of individuals in their 80s. Electrical impulses
move randomly throughout the atria, causing the atria to quiver
instead of contracting in a coordinated rhythm. Common
symptoms are palpitations (uncomfortable sensations in the
chest from missed heartbeats), fatigue, and shortness of breath.
Patients with paroxysmal AF (irregular heartbeats occur
periodically and episodically) and permanent or persistent AF
(irregular heartbeats continue indefinitely) are at a much greater
risk for stroke. This is because ineffective atrial contractions can
lead to the formation of blood clots in the left atrial appendage (the
area where clots form) that may travel to the brain. Also,
sometimes AF can make the heart beat very fast for long periods of
time, leading to weakening of the heart muscle.
The risk for stroke with AF can be reduced by 80% with the use of
anticoagulants (blood thinners such as warfarin) and
anticoagulants called DOACs (direct oral anticoagulants).
Examples of DOACs are apixaban (Eliquis), dabiatran (Pradaxa),
714
and rivaroxaban (Xarelto). Other medications are used to reset the
rhythm of the heart or control its rate.
In ventricular fibrillation (VF), electrical impulses move randomly
throughout the ventricles. This life-threatening situation may result
in sudden cardiac death or cardiac arrest (sudden stoppage of
heart movement) unless help is provided immediately. If treatment
is immediate, VF can be interrupted with defibrillation
(application of an electrical shock). Defibrillation stops electrical
activity in the heart for a brief moment so that normal rhythm
takes over.
An implantable cardioverter-defibrillator (ICD) is a small
electrical device that is implanted inside the chest (near the
collarbone) to sense arrhythmias and terminate them with an
electric shock. Candidates for ICDs are people who have had or are
at high risk for having ventricular tachycardia, ventricular
fibrillation, and cardiac arrest. Automatic external defibrillators
(AEDs) may be found in workplaces, airports, and other public
places and are used in an emergency situation to reverse
ventricular fibrillation.
Catheter ablation is a minimally invasive treatment to treat cardiac
arrhythmias. The technique, using radiofrequency energy
delivered from the tip of a catheter inserted through a blood vessel
and into the heart, destroys tissue that causes arrhythmias.
Supraventricular tachycardia (SVT), atrial flu er, atrial fibrillation,
and ventricular tachycardia (VT) may be treated with ablation
when clinically indicated. This procedure may provide a
permanent cure in many clinical situations.
Abnormalities in the heart at birth.
congenital heart
disease
The following conditions are congenital anomalies resulting from some failure in the
development of the fetal heart.
1. coarctation of
Narrowing (coarctation) of the aorta.
the aorta (CoA)
Figure 11-14A shows coarctation of the aorta. Surgical treatment
consists of removal of the constricted region and end-to-end
anastomosis of the aortic segments.
2. patent ductus
Passageway (ductus arteriosus) between the aorta and the
arteriosus
pulmonary artery remains open (patent) after birth.
(PDA)
The ductus arteriosus normally closes after birth, but in this
congenital condition it remains open (see Figure 11-14B), resulting
in the flow of oxygenated blood from the aorta into the pulmonary
artery. PDA occurs in premature infants, causing cyanosis, fatigue,
and rapid breathing. Although the defect often closes on its own
within months after birth, treatment may be necessary if patency
continues. Treatments include use of a drug (indomethacin) to
promote closure; surgery via catheterization (with coil
embolization to “plug” the ductus); and ligation (tying off)
performed through a small incision between the ribs.
3. septal defects
Small holes in the wall between the atria (atrial septal defects) or
the ventricles (ventricular septal defects). Figure 11-15A shows a
ventricular septal defect.
Although many septal defects close spontaneously, others require
open heart surgery to close the hole between heart chambers, or
they may be repaired through minimally invasive surgery, using a
catheter inserted through a blood vessel leading to the heart. A
heart-lung machine is connected to the patient's circulatory system
715
4. tetralogy of
Fallot (fah-LO)
congestive heart
failure (CHF)
during open heart surgery to relieve the heart and lungs of
pumping and oxygenation functions during surgery.
Congenital malformation involving four (tetra-) distinct heart
defects.
The condition, named for Étienne-Louis Fallot, the French
physician who described it in 1888, is illustrated in Figure 11-15B.
The four defects are:
• Pulmonary artery stenosis. Pulmonary artery is narrow or
obstructed.
• Ventricular septal defect. Large hole between two ventricles lets
venous blood pass from the right to the left ventricle and out to the
aorta without oxygenation.
• Shift of the aorta to the right. Aorta overrides the interventricular
septum. Oxygen-poor blood passes from the right ventricle to the
aorta.
• Hypertrophy of the right ventricle. Myocardium works harder to
pump blood through a narrowed pulmonary artery.
An infant with this condition is described as a “blue baby” because
of the extreme degree of cyanosis present at birth. Surgery for
tetralogy of Fallot includes a patch closure of the ventricular septal
defect and removing obstruction to the outflow at the pulmonary
artery.
Other congenital conditions such as transposition of the great
arteries (TGA) (pulmonary artery arises from the left ventricle and
the aorta from the right ventricle) cause cyanosis and hypoxia as
well. Surgical correction of TGA involves an arterial switch
procedure (pulmonary artery and aorta are reconnected in their
proper positions).
Heart is unable to pump its required amount of blood.
There are two types of congestive heart failure: systolic and
diastolic. In systolic CHF, there is a reduced ejection fraction (the
amount of blood that leaves the left ventricle). Less blood is
pumped from the heart. In diastolic CHF, fluid backs up in the
lungs and other parts of the body.
Symptoms of CHF include shortness of breath, exercise
intolerance, and fluid retention. Pulmonary edema (fluid
accumulation in the lungs) and swelling or edema in the legs, feet,
and ankles are common. Treatment includes lowering dietary
intake of sodium and the use of diuretics to promote fluid loss.
For patients with CHF with a reduced ejection fraction and heart
bundle branch block cardiac resynchronization therapy (CRT)
devices may be used. These implanted devices consist of a pulse
generator and thin, insulated wires and function like a normal
pacemaker and defibrillation devices.
If drug therapy and lifestyle changes fail to control congestive
heart failure, heart transplantation may be the only treatment
option. While waiting for a transplant, patients may need a device
to assist the heart's pumping. A left ventricular assist device
(LVAD) is a booster pump implanted in the abdomen, with a
cannula (tube) inserted into the left ventricle. It pumps blood out of
the heart to all parts of the body. LVAD may be used either as a
“bridge to transplant” or as a “destination” therapy when heart
transplantation is not possible. Because of the severe shortage of
donor hearts, research efforts are directed at developing total
artificial hearts.
716
coronary artery
disease (CAD)
endocarditis
Disease of the arteries surrounding the heart.
The coronary arteries are a pair of blood vessels that arise from the
aorta and supply oxygenated blood to the heart. After blood leaves
the heart via the aorta, a portion is at once led back over the surface
of the heart through the coronary arteries.
CAD usually is the result of atherosclerosis. This is the deposition
of fa y compounds on the inner lining of the coronary arteries (any
other artery can be similarly affected). The ordinarily smooth
lining of the artery becomes roughened as the atherosclerotic
plaque collects in the artery.
The plaque first causes plugging of the coronary artery. Next, the
roughened lining of the artery may rupture or cause abnormal
clo ing of blood, leading to thrombotic occlusion (blocking of the
coronary artery by a clot). Blood flow is decreased (ischemia) or
stopped entirely, leading to death (necrosis) of a part of the
myocardium. This sequence of events constitutes a myocardial
infarction, or heart a ack, and the area of dead myocardial tissue
is known as an infarct. The infarcted area is eventually replaced by
scar tissue. Figure 11-16 shows coronary arteries branching from
the aorta and illustrates coronary artery occlusion leading to
ischemia and infarction of heart muscle. Figure 11-17 is a
photograph of myocardium after an acute myocardial infarction.
Acute coronary syndromes (ACSs) are conditions caused by
myocardial ischemia. These conditions are unstable angina (chest
pain at rest or chest pain of increasing frequency) and myocardial
infarction (Figure 11-18).
Patients with ACSs benefit from early angiography (x-ray imaging
of coronary arteries) and PCI (percutaneous coronary intervention
with a balloon catheter and stents) or CABG (coronary artery
bypass grafting) to improve blood flow to the heart muscle
(revascularization). Drugs used to treat ACSs are anticoagulants
and antiplatelet agents such as aspirin and clopidogrel (Plavix),
prasugrel (Effient), and ticagrelor (Brilinta).
For acute a acks of angina, nitroglycerin is given sublingually
(under the tongue). This drug, one of several called nitrates, is a
vasodilator that increases coronary blood flow and lowers blood
pressure. Nitrates also produce venodilation to reduce venous
return and decrease myocardial oxygen consumption, both of
which help decrease the work of the heart.
Physicians advise patients to avoid risk factors such as smoking,
obesity, and lack of exercise, and they prescribe effective drugs to
prevent CAD and ACSs. These drugs include aspirin (to prevent
clumping of platelets), beta blockers (to reduce the force and
speed of the heartbeat and to lower blood pressure), ACE
inhibitors (to reduce high blood pressure and the risk of future
heart a ack even if the patient is not hypertensive), calcium
channel blockers (to relax muscles in blood vessels), and statins
(to lower cholesterol levels).
Cardiac surgeons perform an open heart operation called coronary
artery bypass grafting (CABG) to treat CAD by replacing clogged
vessels. Interventional cardiologists perform percutaneous
coronary intervention (PCI), in which catheterization with
balloons and stents opens clogged coronary arteries.
Inflammation of the inner lining of the heart.
717
hypertensive
heart disease
mitral valve
prolapse (MVP)
murmur
pericarditis
rheumatic heart
disease
Damage to the heart valves from infection (bacterial endocarditis)
produces lesions called vegetations (resembling cauliflower) that
break off into the bloodstream as emboli (material that travels
through the blood). The emboli can lodge in other vessels, leading
to a transient ischemic a ack (TIA), or a stroke, or in small vessels
of the skin, where multiple pinpoint hemorrhages known as
petechiae (from the Italian petechio, a flea bite) form. Antibiotics
can cure bacterial endocarditis.
High blood pressure affecting the heart.
This condition results from narrowing of arterioles, which leads to
increased pressure in arteries. The heart is affected (left ventricular
hypertrophy) because it pumps more vigorously to overcome the
increased resistance in the arteries.
Improper closure of the mitral valve.
This condition occurs because the mitral valve enlarges and
prolapses into the left atrium during systole. The physician hears a
midsystolic click on auscultation (listening with a stethoscope) and
occasionally mitral regurgitation (backflow of blood into the left
atrium). Most people with MVP live normal lives, but severely
prolapsed valves can be associated with severe mitral regurgitation
and on rare occasions may become infected (endocarditis).
Extra heart sound, heard between normal beats.
Murmurs are heard with the aid of a stethoscope and usually are
caused by a valvular defect or disease that disrupts the smooth
flow of blood in the heart. They also are heard in cases of
interseptal defects, in which blood flows abnormally between
chambers through holes in the septa. Functional murmurs are not
caused by valve or septal defects and do not seriously endanger a
person's health.
A bruit (BRU-e) is a murmur heard on auscultation. It is the
turbulent flow of blood through a vessel. A thrill, which is a
vibration felt on palpation of the chest, often accompanies a
murmur.
Inflammation of the membrane (pericardium) surrounding the
heart.
In most instances, pericarditis results from a viral illness or the
etiology may be idiopathic. Bacteria and viruses cause the
condition, or the etiology may be idiopathic. Malaise, fever, and
chest pain occur, and auscultation often reveals a pericardial
friction rub (heard as a scraping or grating sound). Compression
of the heart caused by collection of fluid in the pericardial cavity is
cardiac tamponade (tăm-pō-NŎD). Treatment includes antiinflammatory drugs and other agents to manage pain. If the
pericarditis is infective, antibiotics or antifungals are prescribed,
depending on the microorganisms detected in specimens obtained
by pericardiocentesis or using blood tests.
Heart disease caused by rheumatic fever.
Rheumatic fever is a childhood disease that follows a streptococcal
infection with sore throat (pharyngitis). The heart valves can be
damaged by inflammation and scarred with vegetations so that
they do not open and close normally (Figure 11-19A). Repeat
streptococcal infection is thought to be required to produce heart
disease, so children with a history of rheumatic fever are treated
with monthly penicillin injections given intramuscularly until the
age of 21.
718
Mitral stenosis, atrial fibrillation, and congestive heart failure,
caused by weakening of the myocardium, also can result from
rheumatic heart disease. Treatment consists of reduced activity,
drugs to control arrhythmia, surgery to repair a damaged valve,
and anticoagulant therapy to prevent emboli from forming.
Artificial and porcine (pig) valve implants can replace deteriorated
heart valves (Figure 11-19B and C).
FIGURE 11-13 A, A dual-chamber, rate-responsive
pacemaker (actual size shown) is designed to detect body
movement and automatically increase or decrease paced heart
rates based on levels of physical activity. B, Cardiac pacemaker
with leads in the right atrium and right ventricle enable it to sense
and pace in both heart chambers. C, Biventricular pacemaker
with leads in the right atrium and the right and left ventricles to
synchronize ventricular contractions.
719
FIGURE 11-14 A, Coarctation of the aorta. Localized
narrowing of the aorta reduces the supply of blood to the lower
part of the body. B, Patent ductus arteriosus. The ductus
arteriosus fails to close after birth, and blood from the aorta flows
through it into the pulmonary artery.
FIGURE 11-15 A, Ventricular septal defect. A hole in the
ventricular septum causes blood to flow from the left ventricle to
the right and into the lungs via the pulmonary artery. B, Tetralogy
of Fallot showing the four defects. The flow of blood is indicated
by the arrows.
720
FIGURE 11-16 A, Ischemia and infarction produced by
coronary artery occlusion. B, Internal view of the heart showing
an area damaged by myocardial infarction.
FIGURE 11-17 Acute myocardial infarction (MI), 5 to 7 days
old. The infarct is visible as a well-demarcated, pale yellow lesion
in the posterolateral region of the left ventricle. The border of the
infarct is surrounded by a dark red zone of acute inflammation.
721
FIGURE 11-18 Acute coronary syndromes: sequence of
pathologic changes leading to cardiac event. A, Atherosclerotic
plaque forms from lipid collection. B, Plaque rupture, causing
platelet aggregation on the plaque. C, Nonocclusive thrombus
forms, causing unstable angina or NSTEMI (non–ST elevation
myocardial infarction). D, Alternatively, formation of an occlusive
thrombus leads to a myocardial infarction or STEMI (ST
elevation myocardial infarction).
722
FIGURE 11-19 A, Acute rheumatic mitral valvulitis with
chronic rheumatic heart disease. Small vegetations are visible
along the line of closure of the mitral valve leaflet (arrows).
Previous episodes of rheumatic valvulitis have caused fibrous
thickening and fusion of the chordae tendineae of the valves. B,
Artificial heart valve. C, Porcine xenograft valve. A xenograft
valve (Greek xen/o means stranger) is tissue that is transferred
from an animal of one species (pig) to one of another species
(human).
How Does a Pacemaker Work?
The pacemaker leads (wires) detect the heart's own electrical activity
and transmit that information to the generator (computer). The
computer analyzes the heart's signals and decides when and where to
pace. If the rate is slow, the generator emits a signal to stimulate
contraction and increase the rate. Pacemakers with multiple leads can
pace the atrium and ventricle in proper sequence. Rate-responsive
pacemakers have sensors that detect body movement and breathing to
then determine the best heart rate.
Palpitation/Palpation
Don't confuse palpitation with palpation, which means to touch, feel,
or examine with the hands and fingers.
Blood Vessels
723
aneurysm
deep vein
thrombosis
(DVT)
hypertension
(HTN)
peripheral
arterial
disease
(PAD)
Raynaud (raNO) disease
(Raynaud's)
varicose
Local widening (dilation) of an arterial wall.
An aneurysm (Greek aneurysma, widening) usually is caused by
atherosclerosis and hypertension or a congenital weakness in the vessel
wall. Aneurysms are common in the aorta but may occur in peripheral
vessels as well. The danger of an aneurysm is rupture and hemorrhage.
Treatment depends on the vessel involved, the site, and the health of the
patient. In aneurysms of small vessels in the brain, treatment is
occlusion of the vessel with small clips. For larger arteries, such as the
aorta, a stent graft may be sewn within the affected vessel. Figure 1120A shows an abdominal aortic aneurysm (called “AAA”), and Figure
11-20B illustrates a stent graft in place. Note that the graft is
anastomosed to the normal portion of the aorta, and the aneurysm sac is
closed around the graft to prevent fistula formation from graft to bowel.
Blood clot (thrombus) forms in a large vein, usually in a lower limb.
This condition may result in a pulmonary embolism (clot travels to the
lung) if not treated effectively. Examples of anticoagulants (bloodthinning drugs) are warfarin (Coumadin) and direct oral anticoagulants
(DOACs). They are used to prevent DVTs and pulmonary emboli (PEs)
.
High blood pressure.
Most high blood pressure is essential hypertension, with no identifiable
cause. Categories of blood pressure readings are shown in Table 11-1.
Diuretics, ACE inhibitors, calcium channel blockers, and beta-blockers
are used to treat essential hypertension. Losing weight, limiting sodium
(salt) intake, stopping smoking, and reducing fat in the diet also can
reduce blood pressure.
In secondary hypertension, the increase in pressure is caused by
another associated lesion, such as glomerulonephritis, pyelonephritis, or
vascular disease, or disease of the adrenal glands.
Blockage of arteries carrying blood to the legs, arms, kidneys, and
other organs.
Any artery can be affected, such as the carotid (neck), femoral (thigh), or
popliteal (back of the knee). A sign of PAD in the lower extremities is
intermi ent claudication (absence of pain or discomfort in a leg at rest,
but pain, tension, and weakness after walking has begun). Treatment is
exercise, avoidance of nicotine (which causes vessel constriction), and
control of risk factors such as hypertension, hyperlipidemia, and
diabetes. Surgical treatment includes endarterectomy and bypass
grafting (from the normal proximal vessel around the diseased area to a
normal vessel distally).
Percutaneous treatments include balloon angioplasty, atherectomy, and
stenting. Embolic protection devices are parachute-like filters used to
capture embolic debris during stenting.
Recurrent episodes of pallor and cyanosis primarily in fingers and
toes.
This is a rare disorder of unknown cause that affects blood flow in
arteries. Raynaud's is sometimes called a disease, phenomenon, or
syndrome. It is marked by brief episodes of intense constriction and
vasospasm of arterioles in young, otherwise healthy women. See Figure
11-21. Episodes can be triggered by cold temperatures, emotional stress,
or cigare e smoking and caffeine.
Raynaud's can be controlled by protecting the body from cold and
avoiding other triggers. Medications that increase blood flow to the
hands and feet may relieve symptoms.
Abnormally swollen and twisted veins, usually occurring in the legs.
724
veins
This condition is caused by damaged valves that fail to prevent the
backflow of blood (Figure 11-22A to C). The blood then collects in the
veins, which distend to many times their normal size. Because of the
slow flow of blood in the varicose veins and frequent injury to the vein,
thrombosis may occur as well. Hemorrhoids (piles) are varicose veins
near the anus.
Physicians now treat varicose veins with sclerotherapy (injections with
sclerosing solution) or laser and pulsed-light treatments to seal off veins.
Surgical interventions such as vein stripping and ligation are used less
frequently.
FIGURE 11-20 A, Abdominal aortic aneurysm (AAA). A
dissecting aortic aneurysm is a splitting or dissection of the
wall of the aorta by blood entering a tear or hemorrhage within
the walls of the vessel. B, Stent graft in place. This stent graft
procedure is an endovascular aneurysm repair or EVAR.
725
FIGURE 11-21 Raynaud disease.
FIGURE 11-22 A, Valve function in normal vein and varicose
vein. B, Varicose veins. C, The slow flow in veins increases
susceptibility to thrombophlebitis (clot formation), edema, and
pigmented skin (blood pools in the lower parts of the leg and
fluid leaks from distended small capillaries). If a thrombus
becomes loosened from its place in the vein, it can travel to the
lungs (pulmonary embolism) and block a blood vessel there.
726
TABLE 11-1
Aortic Aneurysms and Marfan Syndrome
Aortic aneurysms are often associated with Marfan syndrome, a
genetic disorder marked by long, thin fingers, great arm span, ocular
lens dislocation, and loose joints. Abraham Lincoln is thought to have
had Marfan syndrome, and the syndrome also has been diagnosed in
basketball and volleyball players who have died suddenly as a result of
ruptured aortic aneurysms.
Warfarin (Coumadin) and DOACs
While the oral anticoagulant warfarin is used to prevent or treat
thromboembolic diseases, treatment with warfarin requires careful
monitoring and is complicated by drug-drug or drug-food interactions.
Direct oral anticoagulants (DOACs) such as apixaban (Eliquis),
edoxaban (Savaysa), dabigatran (Pradaxa), and rivaroxaban (Xarelto)
address these limitations and have been approved by the Food and
Drug Administration (FDA) for anticoagulation in non-valvular atrial
fibrillation and for the prevention and treatment of DVTs and PEs.
Study Section
Practice spelling each term and know its meaning.
727
acute
coronary
syndromes
(ACSs)
angina
(pectoris)
angiotensinconverting
enzyme
(ACE)
inhibitor
auscultation
Unstable angina and myocardial infarction (heart a ack), which are
consequences of plaque rupture in coronary arteries.
Chest pain resulting from myocardial ischemia. Stable angina occurs
predictably with exertion; unstable angina is chest pain that occurs more
often and with less exertion.
Antihypertensive drug that blocks the conversion of angiotensin I to
angiotensin II, causing blood vessels to dilate. It prevents heart a acks,
CHF, stroke, and death. See Table 21-7 on page 835 for names of ACE
inhibitors and other cardiovascular drugs.
Listening for sounds in blood vessels or other body structures, typically
using a stethoscope.
beta blocker Drug used to treat angina, hypertension, and arrhythmias. It blocks the
action of epinephrine (adrenaline) at receptor sites on cells, slowing the
heartbeat and reducing the workload on the heart.
biventricular Device enabling ventricles to beat together (in synchrony) so that more
pacemaker
blood is pumped out of the heart.
bruit
Abnormal blowing or swishing sound heard during auscultation of an
artery or organ.
calcium
Drug used to treat angina and hypertension. It dilates blood vessels by
channel
blocking the influx of calcium into muscle cells lining vessels.
blocker
cardiac arrest Sudden, unexpected stoppage of heart action, often leading to sudden
cardiac death.
cardiac
Pressure on the heart caused by fluid in the pericardial space.
tamponade
claudication Pain, tension, and weakness in a leg after walking has begun, but absence of
pain at rest.
digoxin
Drug that treats arrhythmias and strengthens the heartbeat.
embolus
Clot or other substance that travels to a distant location and suddenly blocks
(plural:
a blood vessel.
emboli)
infarction
Area of dead tissue.
nitrates
Drugs used in the treatment of angina. They dilate blood vessels, increasing
blood flow and oxygen to myocardial tissue.
nitroglycerin Nitrate drug used in the treatment of angina.
occlusion
Closure of a blood vessel due to blockage.
palpitations Uncomfortable sensations in the chest related to cardiac arrhythmias, such
as premature ventricular contractions (PVCs).
patent
Open.
pericardial
Scraping or grating noise heard on auscultation of the heart; suggestive of
friction rub
pericarditis.
petechiae
Small, pinpoint hemorrhages.
statins
Drugs used to lower cholesterol in the bloodstream.
thrill
Vibration felt over an area of turmoil in blood flow (as a blocked artery).
vegetations
Clumps of platelets, clo ing proteins, microorganisms, and red blood cells
on diseased heart valves.
728
Laboratory Tests and Clinical
Procedures
Laboratory Tests
BNP test
cardiac
biomarkers
lipid tests
(lipid profile)
lipoprotein
electrophoresis
Measurement of BNP (brain natriuretic peptide) in blood.
BNP is elevated in patients with heart failure, and it is useful in the
diagnosis of CHF in patients with dyspnea who come to the
emergency department. Its presence also identifies patients at risk for
complications when presenting with acute coronary syndromes (e.g.,
myocardial infarction, unstable angina). It is secreted when the heart
becomes overloaded, and it acts as a diuretic to help heart function
return to normal. Cardiologists also measure NT-proBNP levels to
assess the degree of heart failure. NT stands for N-terminal.
The reference to brain in this term originates from the initial
identification of the protein in the brain of a pig.
Chemicals are measured in the blood as evidence of a heart a ack.
Damaged heart muscle releases chemicals into the bloodstream. The
substances tested for are troponin-I (cTnI) and troponin-T (cTnT).
Troponin is a heart muscle protein released into circulation after
myocardial injury.
C-reactive protein (CRP) is a biomarker of inflammation. Highsensitivity CRP (Hs-CRP) is useful in predicting risk for heart a ack,
stroke, or other major heart disease.
Measurement of cholesterol and triglycerides (fats) in a blood
sample.
High levels of lipids are associated with atherosclerosis. The general
guideline for total cholesterol in the blood is less than 200 mg/dL.
Saturated fats (of animal origin, such as milk, bu er, and meats)
increase cholesterol in the blood, whereas polyunsaturated fats (of
vegetable origin, such as corn and safflower oil) decrease blood
cholesterol.
Treatment of hyperlipidemia includes proper diet (low-fat, high-fiber
intake) and exercise. Niacin (a vitamin) also helps reduce lipids. Drug
therapy includes statins, which reduce the risk of heart a ack, stroke,
and cardiovascular death. Statins lower cholesterol by reducing its
production in the liver. Examples are simvastatin (Zocor), atorvastatin
(Lipitor), pravastatin (Pravachol), and rosuvastatin (Crestor).
Lipoproteins (combinations of fat and protein) are physically
separated and measured in a blood sample.
Examples of lipoproteins are low-density lipoprotein (LDL) and
high-density lipoprotein (HDL). High levels of LDL are associated
with atherosclerosis. The National Guideline for LDL is less than 130
mg/dL in normal persons and less than 70 mg/dL in patients with
CAD, PAD, and diabetes mellitus. High levels of HDL protect adults
from atherosclerosis. Factors that increase HDL are exercise and
alcohol consumption in moderation.
Clinical Procedures: Diagnostic
X-Ray and Electron Beam Tests
729
angiography
computed
tomography
angiography
(CTA)
digital
subtraction
angiography
(DSA)
electron
beam
computed
tomography
(EBCT or
EBT)
X-ray imaging of blood vessels after injection of contrast material.
Arteriography is x-ray imaging of arteries after injection of contrast via a
catheter into the aorta or an artery.
Three-dimensional x-ray images of the heart and coronary arteries
using computed tomography (64-slice CT scanner).
This newer technique takes hundreds of images of the heart per second.
Cross-sectional images are assembled by computer into a threedimensional picture. It is less invasive than angiography (contrast
material is injected into a small peripheral vein with a small needle) and
provides excellent views of the coronary arteries for diagnosis of
coronary artery disease (Figure 11-23A).
Video equipment and a computer produce x-ray images of blood
vessels.
After taking an initial x-ray picture and storing it in a computer,
physicians inject contrast material and take a second image of that area.
The computer compares the two images and subtracts digital data for the
first from the second, leaving an image of vessels with contrast.
Electron beams and CT identify calcium deposits in and around
coronary arteries to diagnose early CAD.
A coronary artery calcium score is derived to indicate future risk of
heart a ack and stroke (see Figure 11-23B).
FIGURE 11-23 A, Computed tomography angiography (CTA)
showing coronary arteries. B, Electron beam computed
tomography showing significant calcification (white areas) in the
coronary arteries, indicating advanced coronary artery disease.
(A, Courtesy Massachusetts General Hospital, Boston.)
Coronary Artery Calcium Score
730
0-99
100-399
>400
low risk
intermediate risk
high risk
A calcium score >400 is associated with a nearly 25% chance of a heart
a ack or stroke occurring within 10 years.
Ultrasound Examination
Doppler
ultrasound
studies
echocardiography
(ECHO)
Sound waves measure blood flow within blood vessels.
An instrument focuses sound waves on blood vessels, and echoes
bounce off red blood cells. The examiner can hear various
alterations in blood flow caused by vessel obstruction. Duplex
ultrasound combines Doppler and conventional ultrasound to
allow physicians to image the structure of blood vessels and
measure the speed of blood flow. Carotid artery occlusion,
aneurysms, varicose veins, and other vessel disorders can be
diagnosed with duplex ultrasound.
Echoes generated by high-frequency sound waves produce
images of the heart (Figure 11-24A).
ECHOs show the structure and movement of the heart. In
transesophageal echocardiography (TEE), a transducer placed in
the esophagus provides ultrasound and Doppler information
(Figure 11-24B). This technique detects cardiac masses, prosthetic
valve function, aneurysms, and pericardial fluid.
FIGURE 11-24 A, Echocardiogram. Notice that in this view,
the ventricles are above the atria. B, Transesophageal
echocardiography.
731
Nuclear Cardiology
positron
emission
tomography
(PET) scan
technetium
Tc 99m
sestamibi
scan
thallium
201 scan
Images show blood flow and myocardial function following uptake of
radioactive glucose.
PET scanning can detect CAD, myocardial function, and differences
between ischemic heart disease and cardiomyopathy.
Technetium Tc 99m sestamibi injected intravenously is taken up in
cardiac tissue, where it is detected by scanning.
This scan is used in persons who have had an MI, to assess the amount of
damaged heart muscle. It also is used with an exercise tolerance test
(ETT-MIBI). Sestamibi is a radioactive tracer compound used to define
areas of poor blood flow in heart muscle.
Concentration of radioactive thallium is measured to give information
about blood supply to the heart muscle.
Thallium studies show the viability of heart muscle. Infarcted or scarred
myocardium shows up as “cold spots.”
Magnetic Resonance Imaging (MRI)
cardiac
MRI
Images of the heart are produced using radiowave energy in a magnetic field.
These images in multiple planes give information about left and right
ventricular function, wall thickness, and fibrosis, aneurysms, cardiac output,
and patency of peripheral and coronary arteries. The magnetic waves emi ed
during MRI could interfere with implanted pacemakers because of their metal
content and heat generation, so it is currently contraindicated for a patient
with a pacemaker to undergo cardiac MRI. However, new MRI-safe
pacemakers have been approved. Magnetic resonance angiography (MRA) is
a type of MRI that gives highly detailed images of blood vessels. Physicians
use MRA to view arteries and blockage inside arteries. Gadolinium is the most
common contrast agent used for MRI procedures.
Other Diagnostic Procedures
732
cardiac
catheterization
electrocardiography
(ECG)
Holter monitoring
stress test
Thin, flexible tube is guided into the heart via a vein or an
artery.
This procedure detects pressures and pa erns of blood flow in
the heart. Contrast may be injected and x-ray images taken of the
heart and blood vessels (Figure 11-25). This procedure may be
used in diagnosis and treatment of heart conditions (see under
percutaneous coronary intervention [PCI] on page 407).
At the time of catheterization, the interventional cardiologist also
may perform intravascular ultrasound (IVUS) to evaluate the
severity of vessel narrowing. It also measures fractional flow
reserve (FFR) to determine the impact of the coronary artery
blockage on blood flow.
Recording of electricity flowing through the heart.
Continuous monitoring of a patient's heart rhythm in hospitals is
performed via telemetry (electronic transmission of data—tele/o
means distant). Sinus rhythm begins in the SA node, and the
normal rate is between 60 to 100 beats per minute. Figure 11-26
shows ECG strips for normal sinus rhythm and several types of
dysrhythmias (abnormal rhythms).
An ECG device is worn during prolonged period to detect
cardiac arrhythmias.
Rhythm changes are correlated with symptoms recorded in a
diary.
Exercise tolerance test (ETT) determines the heart's response to
physical exertion (stress).
A common protocol uses 3-minute stages at set speeds and
elevations of a treadmill. Continual monitoring of vital signs and
ECG rhythms is important in the diagnosis of CAD and left
ventricular function.
FIGURE 11-25 Transradial cardiac catheterization. The
catheter is passed retrograde (backward) from the radial artery
into the aorta and then into the left ventricle.
733
FIGURE 11-26 ECG rhythm strips showing normal sinus rhythm
and dysrhythmias (arrhythmias).
Clinical Procedures: Treatment
734
catheter
ablation
coronary artery
bypass grafting
(CABG)
defibrillation
endarterectomy
extracorporeal
circulation
heart
transplantation
percutaneous
coronary
intervention
(PCI)
Brief delivery of radiofrequency energy to ablate (remove) areas of
heart tissue that may be causing arrhythmias.
A catheter is guided through a vein in the leg to the vena cava and
into the heart. The abnormal electrical pathway is located and ablated
(destroyed) using energy emi ed from the catheter. See Figure 1127A.
Arteries and veins are anastomosed to coronary arteries to detour
around blockages.
Internal mammary (breast) and radial (arm) arteries and saphenous
(leg) vein grafts are used to keep the myocardium supplied with
oxygenated blood (Figure 11-27B). Cardiac surgeons perform
minimally invasive CABG surgery using smaller incisions instead of
the traditional sternotomy to open the chest. Vein and artery grafts are
removed endoscopically through small incisions as well.
Although most operations are performed with a heart-lung machine
(“on pump”), an increasing number are performed “off pump” with a
beating heart. See In Person: Coronary Artery Bypass Surgery, page
412.
Brief discharges of electricity are applied across the chest to stop
dysrhythmias (ventricular fibrillation).
For patients at high risk for sudden cardiac death from ventricular
dysrhythmias, an implantable cardioverter-defibrillator (ICD) or
automatic implantable cardioverter-defibrillator (AICD) is placed in
the upper chest.
Cardioversion is another technique using lower energy to treat atrial
fibrillation, atrial flu er, and supraventricular tachycardia.
Surgical removal of plaque from the inner layer of an artery.
Fa y deposits (atheromas) and thromboses are removed to open
clogged arteries. Carotid endarterectomy is a procedure to remove
plaque buildup in the carotid artery to reduce risk of stroke.
Heart-lung machine diverts blood from the heart and lungs while
the heart is repaired.
Blood leaves the body, enters the heart-lung machine, where it is
oxygenated, and then returns to a blood vessel (artery) to circulate
through the bloodstream. The machine uses the technique of
extracorporeal membrane oxygenation (ECMO).
Donor heart is transferred to a recipient.
While waiting for a transplant, a patient may need a left ventricular
assist device (LVAD), which is a booster pump implanted in the chest
or abdomen with cannulae (flexible tubes) from the left ventricle to
the ascending aorta.
Balloon-tipped catheter is inserted into a coronary artery to open the
artery; stents are put in place.
An interventional cardiologist places the catheter in the femoral or
radial artery and then threads it up the aorta into the coronary artery.
Stents (expandable slo ed metal tubes that serve as permanent
scaffolding devices) create wide lumens and make restenosis less
likely. Drug-eluting stents (DESs) are coated with polymers that
elute (release) anti-inflammatory and antiproliferative drugs to
prevent scar tissue formation leading to restenosis (Figure 11-28).
Other devices are bioabsorbable vascular scaffolds (BVSs), made of
dissolvable material, and drug-coated balloons (DCBs) that release
paclitaxel.
PCI techniques include percutaneous transluminal coronary
angioplasty (PTCA), stent placement, laser angioplasty (a small laser
735
thrombolytic
therapy
transcatheter
aortic valve
replacement
(TAVR)
on the tip of a catheter vaporizes plaque), and atherectomy.
Drugs to dissolve clots are injected into the bloodstream of patients
with coronary thrombosis.
Tissue plasminogen activator (tPA) and streptokinase restore blood
flow to the heart and limit irreversible damage to heart muscle. The
drugs are given within 12 hours after the onset of a heart a ack.
Thrombolytic agents reduce the mortality rate in patients with
myocardial infarction by 25%.
Placement of a balloon-expandable aortic heart valve into the body
via a catheter.
The catheter is guided into the heart through the femoral artery, and a
stent valve device is inserted using the catheter. This is a newer,
minimally invasive catheter-based technology used to treat aortic
stenosis.
FIGURE 11-27 A, Catheter ablation. SVT, atrial flutter, AF, and
VT may be treated with ablation when clinically indicated. B,
Coronary artery bypass grafting (CABG) surgery with
anastomosis of vein and arterial grafts. (1) A section of a vein is
removed from the leg and anastomosed (upside down because
of its directional valves) to a coronary artery, to bypass an area of
arteriosclerotic blockage. (2) An internal mammary artery is
grafted to a coronary artery to bypass a blockage.
736
FIGURE 11-28 Placement of an intracoronary artery drugeluting stent. A, The stent is positioned at the site of the lesion.
B, The balloon is inflated, expanding the stent and compressing
the plaque. C, When the balloon is withdrawn, the stent supports
the artery and releases a drug to reduce the risk of restenosis.
Stents are stainless-steel scaffolding devices that help hold open
arteries, such as the coronary, renal, and carotid arteries.
Abbreviations
737
AAA
ACE
inhibitor
ACLS
ACS
ADP
abdominal aortic aneurysm
angiotensin-converting enzyme inhibitor
advanced cardiac life support; CPR plus drugs and defibrillation
acute coronary syndrome
adenosine diphosphate; ADP blockers are used to prevent cardiovascularrelated death, heart a ack, and strokes and after all stent procedures
AED
automatic external defibrillator
AF, a-fib
atrial fibrillation
AICD
automatic implantable cardioverter-defibrillator
AMI
acute myocardial infarction
ARB
angiotensin II receptor blocker
ARVD
arrhythmogenic right ventricular dysplasia
AS
aortic stenosis
ASD
atrial septal defect
AV, A-V
atrioventricular
AVR
aortic valve replacement
BBB
bundle branch block
BNP
brain natriuretic peptide; elevated in congestive heart failure
BP
blood pressure
CABG
coronary artery bypass grafting
CAD
coronary artery disease
CCTA
coronary computed tomography angiography
CCU
coronary care unit
Cath
catheterization
CHF
congestive heart failure
CK
creatine kinase; enzyme released after injury to heart muscles
CoA
coarctation of the aorta
CPR
cardiopulmonary resuscitation
CRT
cardiac resynchronization therapy; biventricular pacing and defibrillation
devices
CTNI or
cardiac troponin-I and cardiac troponin-T; troponin is a protein released into
cTnI; CTNT the bloodstream after myocardial injury
or cTnT
DES
drug-eluting stent
DOAC
direct oral anticoagulant
DSA
digital subtraction angiography
DVT
deep vein thrombosis
ECG; also
electrocardiography
seen as EKG
ECHO
echocardiography
ECMO
extracorporeal membrane oxygenation
EF
ejection fraction; measure of the amount of blood that pumps out of the heart
with each beat
EPS
electrophysiology study; electrode catheters inserted in veins and threaded
into the heart to measure electrical conduction (tachycardias are provoked
and analyzed)
ETT
exercise tolerance test
ETT-MIBI
exercise tolerance test combined with a radioactive tracer (sestamibi) scan
EVAR
endovascular aneurysm repair
FFR
fractional flow reserve
HDL
high-density lipoprotein; high blood levels mean lower incidence of coronary
artery disease
738
hsCRP
high-sensitivity C-reactive protein; biomarker for inflammation in prediction
of heart a ack risk
HTN
hypertension (high blood pressure)
IABP
intra-aortic balloon pump; used to support patients in cardiogenic shock
ICA
invasive coronary angiography
ICD
implantable cardioverter-defibrillator
IVUS
intravascular ultrasound
LAD
left anterior descending (coronary artery)
LBBB
left bundle branch block
LDL
low-density lipoprotein; high blood levels lead to cholesterol buildup in
arteries
LMWH
low-molecular-weight heparin
LV
left ventricle
LVAD
left ventricular assist device
LVEF
left ventricular ejection fraction
LVH
left ventricular hypertrophy
MI
myocardial infarction
MUGA
multiple-gated acquisition scan; a radioactive test of heart function
MVP
mitral valve prolapse
NSR
normal sinus rhythm
NT-proBNP N-terminal pro-peptide of BNP
NSTEMI
non–ST elevation MI
PAC
premature atrial contraction
PAD
peripheral arterial disease
PCI
percutaneous coronary intervention
PDA
patent ductus arteriosus
PE
pulmonary embolus
PVC
premature ventricular contraction
RBBB
right bundle branch block
SA, S-A
sinoatrial node
node
SCD
sudden cardiac death
SOB
shortness of breath
SPECT
single photon emission computed tomography; used for myocardial imaging
with sestamibi scans
STEMI
ST elevation myocardial infarction
SVT
supraventricular tachycardia; rapid heartbeats arising from the atria and
causing palpitations, SOB, and dizziness
TAVR
transcatheter aortic valve replacement
TEE
transesophageal echocardiography
TEVAR
thoracic endovascular aneurysm repair
TGA
transposition of the great arteries
tPA
tissue-type plasminogen activator; a drug used to prevent thrombosis
UA
unstable angina; chest pain at rest or of increasing frequency
VF
ventricular fibrillation
VSD
ventricular septal defect
VT
ventricular tachycardia
WPW
Wolff-Parkinson-White syndrome; abnormal ECG pa ern associated with
paroxysmal tachycardia
739
Practical Applications
Answers to Practical Applications are found on page 425.
Operating Room Schedule: General Hospital
Match the operative treatment in Column I with the appropriate
surgical indication (diagnosis) in Column II.
COLUMN I
1. coronary artery bypass
grafting
2. left carotid
endarterectomy
3. sclerosing injections and
laser treatment
4. LV aneurysmectomy
5. atrial septal defect repair
6. left ventricular assist
device
7. pericardiocentesis
8. aortic valve replacement
9. pacemaker implantation
10. femoral-popliteal bypass
grafting
COLUMN II
_______ A. Congestive heart failure
B. Cardiac tamponade (fluid in the space
_______ surrounding the heart)
C. Atherosclerotic occlusion of a main artery leading
_______ to the head
D. Congenital hole in the wall of the upper chamber
_______ of the heart
_______ E. Disabling angina and extensive coronary
_______ atherosclerosis despite medical therapy
F. Peripheral vascular disease
_______ G. Heart block
_______ H. Varicose veins
I. Protrusion of the wall of a lower heart chamber
_______
J. Aortic stenosis
_______
New and Important Cardiovascular Drugs
Antiplatelet agents: These drugs are used after stent placement
or after ACS (acute coronary syndromes).
• clopidrogrel (Plavix)
• prasugrel (Effient)
• ticagrelor (Brilinta)
DOACs (direct oral anticoagulant agents): These drugs are used
to prevent strokes related to atrial fibrillation and clot formation.
• apixaban (Eliquis)
• dabidatran (Pradaxa)
• edoxaban (Savaysa
• rivaroxaban (Xarelto)
Entresto: Exciting new combination drug to treat heart failure. It
has outperformed traditional angiotensin-converting enzyme
(ACE) inhibitors in a major clinical trial and has been shown to
reduce mortality due to heart failure.
• valsartan/sacubitril
Clinical Cases: What's Your Diagnosis?
740
Case 1: A 24-year-old woman with a history of palpitations [heartbeat
is unusually strong, rapid, or irregular, so that patient is aware of it]
and vague chest pains enters the hospital. With the patient supine, you
hear a midsystolic click that is followed by a grade 3/6 [moderately
loud—6/6 is loud and 1/6 is quiet] honking murmur.
1. Your diagnosis is:
a. Tetralogy of Fallot
b. Mitral valve prolapse
c. Raynaud disease
d. Congestive heart failure
Case 2: Mr. Smith is brought urgently to the Emergency Room for
prolonged chest pain. His ECG showed ST segment elevation in the
anterior leads and he was then transferred to the cardiac cath lab. An
angiogram reveals 100% blockage of the left anterior descending (LAD)
coronary artery. PCI with stent is recommended.
1. What did the ECG reveal?
a. NSTEMI and unstable angina
b. Aortic aneurysm
c. CHF
d. STEMI
2. Your diagnosis for this patient is:
a. Heart a ack
b. Rheumatic heart disease
c. Unstable angina
d. Patent ductus arteriosus
3. What treatment is recommended?
a. Coronary artery bypass grafting
b. Catheterization with drug-eluting stent placement
c. Defibrillation and cardioversion
d. Thrombolytic drugs
Case 3: A 42-year-old female runner recovering from an upper
respiratory infection comes to the ED complaining of chest pain that is
sharp and constant, worse when she is lying down and decreased with
si ing up and leaning forward. Serum troponin levels rule out an acute
MI. The ED physician auscultates a pericardial friction rub.
1. What's your diagnosis for this patient?
a. Myocardial ischemia
b. Unstable angina and NSTEMI
741
c. Endocarditis
d. Pericarditis
2. The danger of this condition is the risk for progression to:
a. Cardiac tamponade
b. Aneurysm
c. Pulmonary embolism
d. Claudication
In Person
Coronary Artery Bypass Surgery
Possible heart a ack? You have to be kidding. I had none of the
supposed symptoms—shortness of breath or chest pain. Instead, I had
bouts of atrial fibrillation off and on for several months. I got tired
easily, and I could feel my blood pressure drop. After lying down for
about an hour, I was fine, so in November 2010 I decided to get it
checked out.
My cardiologist decided to do a stress test. He put me on a treadmill,
which seemed like an eternity, and then did some ultrasound on me. I
work out every day on a treadmill and a recumbent bike, so the test on
742
the treadmill wasn't that difficult, although I loved the words “just a
couple of seconds to go.”
The cardiologist at Johns Hopkins told me after the stress test that it
appeared that I had a slight blockage of an artery. No problem, I
thought.
Angioplasty was recommended. During angioplasty, a catheter was
inserted up my right arm, and although I was lightly sedated, I still felt
it, particularly when the doctor hit a problem and had to make a slight
correction. I was certain that they would put in a stent and I'd be home
by the weekend. “No,” said my doctor. “You have three blockages and
will need bypass surgery.” I thought he must be talking about someone
else. That can't be me!
The blockages did not require immediate surgery. After all, I was
pain free and asymptomatic. Still, I asked for an early date for surgery,
and it was set for January 11, 2011. (That was 1/11/11. How odd.)
The triple coronary artery bypass opened me up like a beached tuna
and made me an official member of the “zipper club.” The atrial
fibrillation was fixed with radiofrequency ablation.
After surgery I had to lie on my back, which meant minimal sleep for
a week. Lasix (a diuretic) was my biggest problem, along with a dozen
pills I had to take far too often. According to my surgeon, who visited
me a day later, things went well, and I was up and walking the
hallways of Hopkins with the help of a nurse and a walker.
I went home in a week. The toughest part of the ordeal, oddly
enough, was trying to get to the bathroom in time and the bumpy ride
home. Those bumps made me hold that pillow [for abdominal support]
as close as I could. Ouch.
After I returned home, two nurses came for home care, and they
were fabulous. I lost about 20 pounds before the surgery and another
17 pounds afterward. I went from 210 pounds to around 173 pounds.
Nowadays, I eat no red meat, nothing with bu er, and as li le fat
and salt as possible. In other words, I eat fish primarily. I work out
every day (between 30 and 60 minutes), and I have regular checkups
with my cardiologist.
I was lucky that the atrial fibrillation alerted my physicians to a
deeper problem that may have resulted in a heart a ack or even death.
Secondly, I was fortunate to have some true professionals on hand to
get me through the darkest days of my life. Many people who had
bypass surgery told me I would have more energy after surgery due to
my new plumbing. That occurred within 6-7 months after my surgery.
Stan Ber was born in Maine and is a graduate of Bowdoin College. He
retired from his career as a sports editor and columnist for the Columbia Flier
and Howard County Times in December 2014 after 44 years. He was inducted
743
into the Howard County Sports Hall of Fame in 2009 and has been recognized
by the Maryland State Legislature.
744
Exercises
Remember to check your answers carefully with the Answers to
Exercises, page 422.
A Match the listed structures with the descriptions
that follow.
aorta
arteriole
atrium
capillary
inferior vena cava
mitral valve
pulmonary artery
pulmonary vein
superior vena cava
tricuspid valve
ventricle
venule
1. valve that lies between the right atrium and the
right ventricle _______________________
2. smallest blood vessel _______________________
3. carries oxygenated blood from the lungs to the
heart _______________________
4. largest artery in the body
_______________________
5. brings oxygen-poor blood into the heart from the
upper parts of the body __________________
6. upper chamber of the heart
_______________________
745
7. carries oxygen-poor blood to the lungs from the
heart _______________________
8. small artery _______________________
9. valve that lies between the left atrium and the left
ventricle _______________________
10. brings blood from the lower half of the body to
the heart _______________________
11. small vein _______________________
12. lower chamber of the heart
_______________________
B Trace the path of blood through the heart. Begin as
the blood enters the right atrium from the venae
cavae (and include the valves within the heart).
1. right atrium______________________
2. ________________________________
3. _______________________________
4. _______________________________
5. _______________________________
6. capillaries of the lung_____________
7. ______________________________
8. ______________________________
9. ___________________________
10. ____________________________
11. __________________________
12. aorta_________________________
C Complete the following sentences.
1. The pacemaker of the heart is the
___________________________________________.
746
2. The sac-like membrane surrounding the heart is the
_____________________________.
3. The wall of the heart between the right and the left
atria is the _____________________.
4. The relaxation phase of the heartbeat is called
__________________________________.
5. Specialized conductive tissue in the wall between
the ventricles is the _______________.
6. The inner lining of the heart is the
____________________________________________.
7. The contractive phase of the heartbeat is called
__________________________________.
8. A gas released as a metabolic product of catabolism
is ____________________________.
9. Specialized conductive tissue at the base of the wall
between the two upper heart chambers is the
_____________________.
10. The inner lining of the pericardium, closely
enveloping the heart, is the ____________________.
11. An abnormal heart sound due to improper closure
of heart valves is a _____________________.
12. The beat of the heart as felt through the walls of
arteries is called the _____________________.
D Complete the following terms using the given
definitions.
1. hardening of arteries: arterio
_____________________
2. disease condition of heart muscle: cardio
_____________________
747
3. enlargement of the heart: cardio
_____________________
4. inflammation of a vein: phleb
_____________________
5. condition of rapid heartbeat:
_____________________ cardia
6. condition of slow heartbeat:
_____________________ cardia
7. high levels of cholesterol in the blood: hyper
_____________________
8. surgical repair of a valve: valvulo
_____________________
9. condition of deficient oxygen: hyp
_____________________
10. pertaining to an upper heart chamber:
_____________________ al
11. narrowing of the mitral valve: mitral
_____________________
12. breakdown of a clot: thrombo
_____________________
E Give the meanings of the following terms.
1. cyanosis
_____________________________________________
___
2. phlebotomy
_____________________________________________
___
3. arterial anastomosis
_____________________________________________
___
748
4. cardiogenic shock
_____________________________________________
___
5. atheroma
_____________________________________________
___
6. arrhythmia
_____________________________________________
___
7. sphygmomanometer
_____________________________________________
___
8. stethoscope
_____________________________________________
___
9. mitral valvulitis
_____________________________________________
___
10. atherosclerosis
_____________________________________________
__
11. vasoconstriction
_____________________________________________
___
12. vasodilation
_____________________________________________
___
F Match the following pathologic conditions of the
heart with their meanings below.
atrial septal defect
coarctation of the aorta
749
congestive heart failure
coronary artery disease
endocarditis
fibrillation
flu er
hypertensive heart disease
mitral valve prolapse
patent ductus arteriosus
pericarditis
tetralogy of Fallot
1. inflammation of the inner lining of the heart
_________________________
2. rapid but regular atrial or ventricular contractions
_________________________
3. small hole between the upper heart chambers;
congenital anomaly ________________________
4. improper closure of the valve between the left
atrium and ventricle during systole
_________________________
5. blockage of the arteries surrounding the heart
leading to ischemia ________________________
6. high blood pressure affecting the heart
_________________________
7. rapid, random, ineffectual, and irregular
contractions of the heart
_________________________
8. inflammation of the sac surrounding the heart
_________________________
750
9. inability of the heart to pump its required amount
of blood _________________________
10. congenital malformation involving four separate
heart defects _________________________
11. congenital narrowing of the large artery leading
from the heart _________________________
12. a duct between the aorta and the pulmonary
artery, which normally closes soon after birth,
remains open _________________________
G Give the meanings of the following terms.
1. heart block
_____________________________________________
_________________________
2. cardiac arrest
_____________________________________________
_______________________
3. palpitations
_____________________________________________
________________________
4. artificial cardiac pacemaker
_____________________________________________
____________
5. thrombotic occlusion
_____________________________________________
________________
6. angina
_____________________________________________
__________________________
7. myocardial infarction
_____________________________________________
_________________
751
8. necrosis
_____________________________________________
__________________________
9. infarction
_____________________________________________
__________________________
10. ischemia
_____________________________________________
__________________________
11. nitroglycerin
_____________________________________________
_______________________
12. digoxin
_____________________________________________
__________________________
13. bruit
_____________________________________________
__________________________
14. thrill
_____________________________________________
__________________________
15. acute coronary syndromes
_____________________________________________
_____________
16. pericardial friction rub
_____________________________________________
_______________
17. deep vein thrombosis
_____________________________________________
______________
752
18. biventricular pacemaker
_____________________________________________
______________
H Match the following terms with their descriptions.
aneurysm
auscultation
claudication
emboli
essential hypertension
murmur
peripheral arterial disease
petechiae
Raynaud disease
rheumatic heart disease
secondary hypertension
vegetations
1. lesions that form on heart valves after damage by
infection ______________________________
2. clots that travel to and suddenly block a blood
vessel ____________________________________
3. small, pinpoint hemorrhages
____________________________________
4. an extra heart sound, heard between normal beats
and caused by a valvular defect or condition that
disrupts the smooth flow of blood through the
heart ____________________________
5. listening with a stethoscope
____________________________________
753
6. heart disease caused by rheumatic fever
____________________________________
7. high blood pressure in arteries when the etiology is
idiopathic ____________________________
8. high blood pressure related to kidney disease
____________________________________
9. episodes of pallor, numbness, and cyanosis in
fingers and toes caused by a temporary
constriction of arterioles
____________________________________
10. local widening of an artery
____________________________________
11. pain, tension, and weakness in a limb after
walking has begun _________________________
12. blockage of arteries in the lower extremities;
etiology is atherosclerosis ______________
I Give short answers for the following.
1. Types of drugs used to treat acute coronary
syndromes include
_____________________________________________
___________________________________________.
2. When damaged valves in veins fail to prevent the
backflow of blood, a condition (swollen, twisted
vein) that results is
____________________________________.
3. Swollen, twisted veins in the rectal region are
called _________________________________.
4. Name the four defects in tetralogy of Fallot from
their descriptions:
754
a. narrowing of the artery leading to the lungs from
the heart _______________________
b. gap in the wall between the ventricles
_________________________________________
c. the large vessel leading from the left ventricle
moves over the interventricular septum
_______________
d. excessive development of the wall of the right
lower heart chamber
_____________________________________________
____________________________________
J Select from the list of cardiac tests and procedures to
complete the definitions that follow.
angiography (arteriography)
cardiac biomarkers
cardiac MRI
coronary artery bypass grafting
defibrillation
echocardiography
electrocardiography
endarterectomy
lipid tests (profile)
lipoprotein electrophoresis
stress test
thallium 201 scan
1. surgical removal of plaque from the inner lining of
an artery ___________________________
2. application of brief electrical discharges across the
chest to stop ventricular fibrillation and pulseless
755
ventricular tachycardia
__________________________________
3. measurement of levels of fa y substances
(cholesterol and triglycerides) in the bloodstream
__________________________________
4. measurement of the heart's response to physical
exertion (patient monitored while jogging on a
treadmill) __________________________________
5. measurement of troponin-T and troponin-I after
myocardial infarction _____________________
6. injection of contrast into vessels and x-ray imaging
__________________________________
7. recording of the electricity in the heart
__________________________________
8. intravenous injection of a radioactive substance
and measurement of its accumulation in heart
muscle __________________________________
9. use of echoes from high-frequency sound waves to
produce images of the heart ______________
10. separation of HDL and LDL from a blood sample
__________________________________
11. anastomosis of vessel grafts to existing coronary
arteries to maintain blood supply to the
myocardium
__________________________________
12. beaming of magnetic waves at the heart to
produce images of its structure _________________
K Give the meanings for the following terms.
1. digital subtraction angiography
_____________________________________________
756
2. heart transplantation
_____________________________________________
__________
3. ETT-MIBI
_____________________________________________
__________
4. Doppler ultrasound
_____________________________________________
__________
5. Holter monitoring
_____________________________________________
__________
6. thrombolytic therapy
_____________________________________________
__________
7. extracorporeal circulation
_____________________________________________
__________
8. cardiac catheterization
_____________________________________________
__________
9. percutaneous coronary intervention
__________________________________________
10. drug-eluting stent
_____________________________________________
__________
11. electron beam computed tomography
_____________________________________________
___
12. CT angiography
_____________________________________________
757
__________
L Identify the following cardiac dysrhythmias from
their abbreviations.
1. AF
_____________________________________________
___
2. VT
_____________________________________________
___
3. VF
_____________________________________________
___
4. PVC
_____________________________________________
___
5. PAC
_____________________________________________
___
M Identify the following abnormal cardiac conditions
from their abbreviations.
1. CHF
_____________________________________________
_
2. VSD
_____________________________________________
_
3. MI
_____________________________________________
_
758
4. PDA
_____________________________________________
_
5. MVP
_____________________________________________
_
6. AS
_____________________________________________
_
7. CAD
_____________________________________________
_
8. ASD
_____________________________________________
_
N Match the listed abbreviations for cardiac tests and
procedures with the explanations/descriptions that
follow.
BNP
CRT
cTnI or cTnT
ECHO
ECMO
ETT
ETT-MIBI
ICD
LDL
LVAD
RFA
759
TEE
1. cardiac serum enzyme test for myocardial
infarction _____________________
2. booster pump implanted in the abdomen with a
cannula leading to the heart as a “bridge to
transplant” _____________________
3. ultrasound imaging of the heart using transducer
within the esophagus_____________________
4. device implanted in the chest that senses and
corrects arrhythmias by shocking the heart
_____________________
5. catheter delivery of a high-frequency current to
damage a small portion of the heart muscle and
reverse an abnormal heart rhythm
_____________________
6. procedure to determine the heart's response to
physical exertion (stress) ___________________
7. cardiac imaging using high-frequency sound waves
pulsed through the chest wall and bounced off
heart structures _____________________
8. radioactive test of heart function with stress test
_____________________
9. technique using heart-lung machine to divert blood
from the heart and lungs while the heart is being
repaired _____________________
10. biventricular pacing to correct serious abnormal
ventricular rhythms _____________________
11. lipoprotein sample is measured
_____________________
12. brain chemical measured to identify patients at
risk for complications after MI and with CHF
760
_____________________
O Spell the term correctly from its definition.
1. pertaining to the heart:
__________________________ ary
2. not a normal heart rhythm: arr
__________________________
3. abnormal condition of blueness:
__________________________ osis
4. relaxation phase of the heartbeat:
__________________________ tole
5. chest pain: __________________________ pectoris
6. inflammation of a vein:
__________________________ itis
7. widening of a vessel: vaso
__________________________
8. enlargement of the heart: cardio
__________________________
9. hardening of arteries with fa y plaque:
__________________________ sclerosis
10. swollen veins in the rectal region:
__________________________ oids
P Match the listed terms for cardiovascular procedures
with the meanings/descriptions that follow.
aneurysmorrhaphy
atherectomy
BNP test
CABG
catheter ablation
embolectomy
761
endarterectomy
PCI
pericardiocentesis
STEMI
thrombolytic therapy
valvotomy
1. incision of a heart valve
__________________________
2. removal of a clot that has traveled into a blood
vessel and suddenly caused occlusion
__________________________
3. coronary artery bypass grafting (to relieve
ischemia) __________________________
4. surgical puncture to remove fluid from the
pericardial space __________________________
5. insertion of a balloon-tipped catheter and stents
into a coronary artery _____________________
6. removal of the inner lining of an artery to make it
wider __________________________
7. suture (repair) of a ballooned-out portion of an
artery __________________________
8. removal of plaque from an artery
__________________________
9. type of acute coronary syndrome
__________________________
10. use of streptokinase and tPA to dissolve clots
__________________________
11. brief delivery of radiofrequency energy to destroy
areas of heart tissue for treating arrhythmias
__________________________
762
12. measures a peptide elevated in patients with heart
failure __________________________
Q Select the boldface terms that best complete each
sentence.
1. Bill was having pain in his chest that radiated up
his neck and down his arm. He called his family
physician, who thought Bill should report to the
local hospital's emergency department (ED)
immediately. The first test performed in the ED
was a/an (stress test, ECG, CABG).
2. Dr. Kelly explained to the family that their
observation of the bluish color of baby Charles's
skin helped her make the diagnosis of a/an
(thrombotic, aneurysmal, septal) defect in the
baby's heart, which needed immediate a ention.
3. Mr. Duggan had a fever of unknown origin. When
the doctors completed an echocardiogram and saw
vegetations on his mitral valve, they suspected
(bacterial endocarditis, hypertensive heart
disease, angina).
4. Claudia's fingers turned white or bluish whenever
she went out into the cold or became stressed. Her
physician thought it might be wise to evaluate her
for (varicose veins, Raynaud's, intermi ent
claudication).
5. Daisy's heart felt as if it was skipping beats every
time she drank coffee. Her physician suggested
that she wear a/an (Holter monitor, LVAD, CABG)
for 24 hours to assess the nature of the arrhythmia.
6. Paola's father and grandfather died of heart a acks.
Her physician tells her that she has inherited a
763
tendency to accumulate fats in her bloodstream.
Blood tests reveal high levels of (enzymes, lipids,
nitroglycerin). Discussing her family history with
her (gynecologist, hematologist, cardiologist), she
understands that she has familial
(hypocholesterolemia, hypercholesterolemia,
cardiomyopathy).
7. While exercising, Bernard experienced a pain
(cramp) in his calf muscle. The pain disappeared
when he was resting. After performing (Holter
monitoring, Doppler ultrasound,
echocardiography) on his leg to assess blood flow,
Dr. Shaw found (stenosis, fibrillation,
endocarditis), indicating poor circulation. She
recommended a daily exercise program, low-fat
diet, careful foot care, and antiplatelet drug
therapy to treat Bernard's intermi ent
(palpitations, hypertension, claudication).
8. Carol noticed that her 6-week-old son Louis had a
slightly bluish or (jaundiced, cyanotic, diastolic)
coloration to his skin. She consulted a pediatric
(dermatologist, hematologist, cardiologist), who
performed (echocardiography, PET scan,
endarterectomy) and diagnosed Louis's condition
as (endocarditis, congestive heart disease,
tetralogy of Fallot).
9. Seventy-eight-year-old John Smith has had
coronary artery disease and high blood pressure
for the past 10 years. His history included an acute
heart a ack, or (MI, PDA, CABG). He often was
tired and complained of (dyspnea, nausea,
migraine headaches) and swelling in his ankles.
His physician diagnosed his condition as (aortic
764
p y
g
aneurysm, congestive heart failure, congenital
heart disease) and recommended restricted salt
intake, diuretics, and an (ACE inhibitor,
antibiotic, analgesic).
10. Sarah had a routine checkup that included
(auscultation, vasoconstriction, vasodilation) of
her chest with a (catheter, stent, stethoscope) to
listen to her heart. Her physician noticed a
midsystolic murmur characteristic of (DVT, MVP,
LDL). An echocardiogram confirmed the diagnosis.
765
Answers to Exercises
A
1. tricuspid valve
2. capillary
3. pulmonary vein
4. aorta
5. superior vena cava
6. atrium
7. pulmonary artery
8. arteriole
9. mitral valve
10. inferior vena cava
11. venule
12. ventricle
B
1. right atrium
2. tricuspid valve
3. right ventricle
4. pulmonary valve
5. pulmonary artery
6. capillaries of the lung
7. pulmonary veins
766
8. left atrium
9. mitral valve
10. left ventricle
11. aortic valve
12. aorta
C
1. sinoatrial (SA) node
2. pericardium
3. interatrial septum
4. diastole
5. atrioventricular bundle or bundle of His
6. endocardium
7. systole
8. carbon dioxide (CO2)
9. atrioventricular (AV) node
10. visceral pericardium (the outer lining is the parietal
pericardium)
11. murmur
12. pulse
D
1. arteriosclerosis
2. cardiomyopathy
3. cardiomegaly
767
4. phlebitis
5. tachycardia
6. bradycardia
7. hypercholesterolemia
8. valvuloplasty
9. hypoxia
10. atrial
11. mitral stenosis
12. thrombolysis
E
1. bluish discoloration of the skin owing to deficient
oxygen in the blood
2. incision of a vein
3. new connection between arteries
4. circulatory failure due to poor heart function
5. mass of yellowish plaque (fa y substance)
6. abnormal heart rhythm
7. instrument to measure blood pressure
8. instrument to listen to sounds within the chest
9. inflammation of the mitral valve
10. hardening of arteries with a yellowish, fa y
substance (plaque)
11. narrowing of a vessel
12. widening of a vessel
768
F
1. endocarditis
2. flu er
3. atrial septal defect
4. mitral valve prolapse
5. coronary artery disease
6. hypertensive heart disease
7. fibrillation
8. pericarditis
9. congestive heart failure
10. tetralogy of Fallot
11. coarctation of the aorta
12. patent ductus arteriosus
G
1. failure of proper conduction of impulses through the
AV node to the atrioventricular bundle (bundle of
His)
2. sudden unexpected stoppage of heart action
3. uncomfortable sensations in the chest associated with
arrhythmias
4. ba ery-operated device that is placed in the chest and
wired to send electrical current to the heart to
establish a normal sinus rhythm
5. blockage of a vessel by a clot
769
6. chest pain resulting from insufficient oxygen being
supplied to the heart muscle (ischemia)
7. area of necrosis (tissue death in the heart muscle;
heart a ack)
8. abnormal condition of death (dead tissue)
9. damage or death of tissue due to deprivation of
oxygen
10. blood is held back from an area of the body
11. nitrate drug used in the treatment of angina
12. drug that treats arrhythmias and strengthens the
heartbeat
13. abnormal sound (murmur) heard on auscultation
14. vibration felt on palpation of the chest
15. consequences of plaque rupture in coronary arteries;
MI and unstable angina
16. scraping or grating noise on auscultation of heart;
indicates pericarditis
17. clot formation in a large vein, usually in lower limb
18. device enabling ventricles to beat in synchrony;
cardiac resynchronization therapy
H
1. vegetations
2. emboli
3. petechiae
4. murmur
770
5. auscultation
6. rheumatic heart disease
7. essential hypertension
8. secondary hypertension
9. Raynaud disease
10. aneurysm
11. claudication
12. peripheral arterial disease
I
1. beta blockers, ACE inhibitors, statins, aspirin, calcium
channel blockers
2. varicose veins
3. hemorrhoids
4. a.pulmonary artery stenosis
b. ventricular septal defect
c. shift of the aorta to the right
d. hypertrophy of the right ventricle
J
1. endarterectomy
2. defibrillation
3. lipid tests (profile)
4. stress test
5. cardiac biomarkers
771
6. angiography (arteriography)
7. electrocardiography
8. thallium 201 scan
9. echocardiography
10. lipoprotein electrophoresis
11. coronary artery bypass grafting
12. cardiac MRI
K
1. Video equipment and a computer produce x-ray
pictures of blood vessels by taking two pictures
(without and with contrast) and subtracting the first
image (without contrast) from the second.
2. A donor heart is transferred to a recipient.
3. Exercise tolerance test combined with a radioactive
tracer scan.
4. An instrument that focuses sound waves on a blood
vessel to measure blood flow.
5. A compact version of an electrocardiograph is worn
during a 24-hour period to detect cardiac
arrhythmias.
6. Treatment with drugs (streptokinase and tPA) to
dissolve clots after a heart a ack.
7. A heart-lung machine is used to divert blood from
the heart and lungs during surgery. The machine
oxygenates the blood and sends it back into the
bloodstream.
772
8. A catheter (tube) is inserted into an artery or vein and
threaded into the heart chambers. Contrast can be
injected to take x-ray pictures, pa erns of blood flow
can be detected, and blood pressures can be
measured.
9. A balloon-tipped catheter is inserted into a coronary
artery to open the artery; stents are put in place.
10. Stents are expandable slo ed tubes that are placed
in arteries during PCI. They release polymers that
prevent plaque from reforming.
11. Electron beams and CT identify calcium deposits in
and around coronary arteries to diagnose CAD.
12. X-ray images of the heart and coronary arteries
obtained using CT technology.
L
1. atrial fibrillation
2. ventricular tachycardia
3. ventricular fibrillation
4. premature ventricular contraction
5. premature atrial contraction
M
1. congestive heart failure
2. ventricular septal defect
3. myocardial infarction
4. patent ductus arteriosus
773
5. mitral valve prolapse
6. aortic stenosis
7. coronary artery disease
8. atrial septal defect
N
1. cTnI or cTnT: cardiac troponin-I and troponin-T
2. LVAD: left ventricular assist device
3. TEE: transesophageal echocardiography
4. ICD: implantable cardioverter-defibrillator
5. RFA: radiofrequency catheter ablation
6. ETT: exercise tolerance test
7. ECHO: echocardiography
8. ETT-MIBI: exercise tolerance test with sestamibi scan
9. ECMO: extracorporeal membrane oxygenation
10. CRT: cardiac resynchronization therapy
11. LDL: low-density lipoprotein; high levels indicate
risk for CAD
12. BNP: brain natriuretic peptide
O
1. coronary
2. arrhythmia
3. cyanosis
4. diastole
774
5. angina pectoris
6. phlebitis
7. vasodilation
8. cardiomegaly
9. atherosclerosis
10. hemorrhoids
P
1. valvotomy
2. embolectomy
3. CABG
4. pericardiocentesis
5. PCI
6. endarterectomy
7. aneurysmorrhaphy
8. atherectomy
9. STEMI (ST segment elevation myocardial infarction)
10. thrombolytic therapy
11. catheter ablation
12. BNP test
Q
1. ECG
2. septal
3. bacterial endocarditis
775
4. Raynaud's
5. Holter monitor
6. lipids; cardiologist; hypercholesterolemia
7. Doppler ultrasound; stenosis; claudication
8. cyanotic; cardiologist; echocardiography; tetralogy of
Fallot
9. MI; dyspnea; congestive heart failure; ACE inhibitor
10. auscultation; stethoscope; MVP
Answers to Practical Applications
Operating Room Schedule
1. E
2. C
3. H
4. I
5. D
6. A
7. B
8. J
9. G
10. F
Clinical Cases: What's Your Diagnosis?
Case 1
1. b
776
Case 2
1. d
2. a
3. b
Case 3
1. d
2. a
Pronunciation of Terms
The terms you have learned in this chapter are presented here with
their pronunciations. The meanings for all the terms are in the MiniDictionary beginning on page 897. You can also hear each term
pronounced on the Evolve website
(h p://evolve.elsevier.com/Chabner/language/).
Vocabulary and Terminology
777
TERM
angiogram
angioplasty
anoxia
aorta
aortic stenosis
apex of the heart
arrhythmia
arterial anastomosis
arteriography
arteriole
arteriosclerosis
artery
atherectomy
atheroma
atherosclerosis
atrial
atrioventricular bundle
atrioventricular node
atrium; pl. atria
brachial artery
bradycardia
bundle of His
capillary
carbon dioxide
cardiogenic shock
cardiomegaly
cardiomyopathy
coronary arteries
cyanosis
deoxygenated blood
diastole
electrocardiogram
endocardium
endothelium
hypercholesterolemia
hypoxia
interventricular septum
mitral valve
mitral valvulitis
myocardium
myxoma
normal sinus rhythm
oxygen
pacemaker
pericardiocentesis
pericardium
phlebotomy
pulmonary artery
pulmonary circulation
pulmonary valve
pulmonary vein
pulse
PRONUNCIATION
AN-je-o-gram
AN-je-o-plas-te
ah-NOK-se-ah
a-OR-tah
a-OR-tik steh-NO-sis
A-pex of the hart
a-RITH-me-ah
ar-TE-re-al ah-nas-to-MO-sis
ar-TE-re-OG-rah-fe
ar-TE-re-ohl
ar-te-re-o-skleh-RO-sis
AR-teh-re
ath-eh-REK-to-me
ath-er-O-mah
ath-er-o-skleh-RO-sis
A-tre-al
a-tre-o-ven-TRIK-u-lar BUN-dil
a-tre-o-ven-TRIK-u-lar node
A-tre-um; A-tre-ah
BRA-ke-al AR-ter-e
bra-de-KAR-de-ah
BUN-dil of hiss
KAP-ih-lah-re
KAR-bon di-OX-ide
kar-de-o-JEN-ik shok
kar-de-o-MEG-ah-le
kar-de-o-mi-OP-ah-the
KOR-o-nair-e AR-teh-reez
si-ah-NO-sis
de-OX-ih-jeh-NA-ted blud
di-AS-to-le
eh-lek-tro-KAR-de-o-gram
en-do-KAR-de-um
en-do-THE-le-um
hi-per-ko-les-ter-ol-E- me-ah
hi-POX-e-ah
in-ter-ven-TRIK-u-lar SEP-tum
MI-tral valv
MI-tral val-vu-LI-tis
mi-o-KAR-de-um
mik-SO-mah
NOR-mal SI-nus RIH-thim
OX-ih-jen
PACE-ma-ker
peh-rih-kar-de-o-sen- TE-sis
peh-rih-KAR-de-um
fleh-BOT-o-me
PUL-mo-nair-e AR-teh-re
PUL-mo-nair-e ser-ku-LA-shun
PUL-mo-nair-e valv
PUL-mo-nair-e vayn
puls
778
TERM
septum; pl. septa
sinoatrial node
sphygmomanometer
stethoscope
systemic circulation
systole
tachycardia
thrombolysis
thrombophlebitis
tricuspid valve
valve
valvotomy
valvuloplasty
vascular
vasoconstriction
vasodilation
vein
vena cava; pl. venae cavae
venipuncture
venous
ventricle
venule
PRONUNCIATION
SEP-tum; SEP-ta
si-no-A-tre-al node
sfig-mo-mah-NOM-eh-ter
STETH-o-skope
sis-TEM-ik ser-ku-LA-shun
SIS-to-le
tah-ke-KAR-de-ah
throm-BOL-ih-sis
throm-bo-fleh-BI-tis
tri-KUS-pid valv
valv
val-VOT-o-me
val-vu-lo-PLAS-te
VAS-ku-lar
vaz-o-kon-STRIK-shun
vaz-o-di-LA-shun
vayn
VE-nah KA-vah; VE-ne KA-ve
ve-nih-PUNK-chur
VE-nus
VEN-trih-kel
VEN-ule
Pathology, Laboratory Tests, and Clinical Procedures
779
TERM
ACE inhibitor
acute coronary syndromes
aneurysm
angina
angiography
atrial fibrillation
atrioventricular block
auscultation
beta blocker
biventricular pacemaker
BNP test
bruit
calcium channel blocker
cardiac arrest
cardiac biomarkers
cardiac catheterization
cardiac MRI
cardiac tamponade
cardioversion
catheter ablation
claudication
coarctation of the aorta
computerized tomography angiography
congenital heart disease
congestive heart failure
coronary artery bypass grafting
coronary artery disease
deep vein thrombosis
defibrillation
digital subtraction angiography
digoxin
Doppler ultrasound
dysrhythmia
echocardiography
electrocardiography
electron beam computed tomography
embolus; pl. emboli
endarterectomy
endocarditis
extracorporeal circulation
fibrillation
flu er
heart block
heart transplantation
hemorrhoids
Holter monitoring
hypertension
hypertensive heart disease
implantable cardioverter defibrillator
infarction
ischemia
PRONUNCIATION
ACE in-HIB-ih-tor
a-KYOOT KOR-o-nair-e SIN-drohms
AN-yoo-rih-zim
an-JI-nah
an-je-OG-rah-fe
A-tre-al fib-rih-LA-shun
a-tre-o-ven-TRIK-u-lar blok
aw-skul-TA-shun
BA-tah BLOK-er
bi-ven-TRIK-u-lar PACE-ma-ker
BNP test
BRU-e
KAL-se-um CHA-nel BLOK-er
KAR-de-ak
KAR-de-ak BI-o-mar-kerz
KAR-de-ak kath-eh-ter-ih-ZA-shun
KAR-de-ak
KAR-de-ak tam-po-NADE
kar-de-o-VER-zhun
KATH-eh-ter ab-LA-shun
klaw-deh-KA-shun
ko-ark-TA-shun of the a-OR-tah
kom-PU-ted to-MOG-rah-fe an-je-OG-rah-fe
kon-JEN-ih-tal hart dih-ZEEZ
kon-JES-tiv hart FAIL-yur
KOR-o-nair-e AR-teh-re BI-pas GRAF-ting
KOR-o-nair-e AR-teh-re dih-ZEEZ
deep vayn throm-BO-sis
de-fib-rih-LA-shun
DIJ-ih-tal sub-TRAK-shun an-je-OG-rah-fe
dih-JOK-sin
DOP-ler UL-trah-sound
dis-RITH-me-ah
ek-o-kar-de-OG-rah-fe
eh-lek-tro-kar-de-OG- rah-fe
eh-LEK-tron beem kom-PU-ted to-MOG-rah-fe
EM-bo-lus; EM-bo-li
en-dar-ter-EK-to-me
en-do-kar-DI-tis
eks-trah-kor-POR-e-al ser-ku-LA-shun
fib-rih-LA-shun
FLUH-ter
hart blok
hart tranz-plan-TA-shun
HEM-uh-roydz
HOL-ter MON-ih-teh-ring
hi-per-TEN-shun
hi-per-TEN-siv hart dih-ZEEZ
im-PLANT-ah-bul kar-de-o-VER-ter de-FIB-rihla-tor
in-FARK-shun
is-KE-me-ah
780
TERM
left ventricular assist device
lipid tests
lipoprotein electrophoresis
mitral stenosis
mitral valve prolapse
murmur
myocardial infarction
nitrates
nitroglycerin
occlusion
palpitations
patent
patent ductus arteriosus
percutaneous coronary intervention
pericardial friction rub
pericarditis
peripheral arterial disease
petechiae
positron emission tomography of the
heart
Raynaud disease
rheumatic heart disease
septal defects
statins
stress test
technetium Tc99m sestamibi scan
telemetry
tetralogy of Fallot
thallium 201 scan
thrill
thrombolytic therapy
thrombotic occlusion
transcatheter aortic valve replacement
varicose veins
vegetations
PRONUNCIATION
left ven-TRIH-ku-lar ah-SIST de-vise
LIH-pid tests
li-po-PRO-teen eh-lek-tro-for-E-sis
MI-tral steh-NO-sis
MI-tral valv PRO-laps
MUR-mer
mi-o-KAR-de-al in-FARK-shun
ni-TRAYTS
ni-tro-GLIS-er-in
o-KLU-zhun
pal-pih-TA-shunz
PA-tent
PA-tent DUK-tus ar-te-re-O-sus
per-ku-TA-ne-us KOR-in-air-e in-ter-VEN-shun
peh-rih-KAR-de-al FRIK-shun rub
peh-rih-kar-DI-tis
peh-RIH-fer-al ar-TE-re-al dih-ZEEZ
peh-TE-ke-i
pos-ih-tron e-MIH-shun to-MOG-rah-fe of the
heart
ra-NO dih-ZEEZ
ru-MAT-ik hart dih-ZEEZ
SEP-tal DE-fekts
STAT-inz
STRESS test
tek-NE-she-um Tc99m ses-tah-MIH-be skan
tel-EM-et-re
teh-TRAH-lo-je of fah-LO
THAL-e-um 201 skan
thril
throm-bo-LIT-ik THER-ah-pe
throm-BOT-ik o-KLU-zhun
tranz-KATH-eh-ter a-OR-tik valv re-PLAYS-ment
VAR-ih-kos vaynz
vej-eh-TA-shunz
Review Sheet
Write the meanings of each word part in the space provided. Check
your answers with the information in the chapter or in the Glossary
(Medical Word Parts—English) at the end of the book.
Combining Forms
781
COMBINING FORM
aneurysm/o
angi/o
aort/o
arter/o, arteri/o
ather/o
atri/o
axill/o
brachi/o
cardi/o
cholesterol/o
coron/o
cyan/o
isch/o
my/o
myx/o
ox/o
pericardi/o
phleb/o
pulmon/o
rrhythm/o
sphygm/o
steth/o
thromb/o
valv/o
valvul/o
vas/o
vascul/o
ven/o, ven/i
ventricul/o
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Suffixes
SUFFIX
-constriction
-dilation
-emia
-graphy
-lysis
-megaly
-meter
-oma
-osis
-plasty
-sclerosis
-stenosis
-tomy
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Prefixes
782
PREFIX
a-, anbradydedysendohyperhypointerperitachytetratri-
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Use the listed cardiovascular anatomy terms to complete the
accompanying chart.
aorta
inferior vena cava
left atrium
left ventricle
lung capillaries
mitral valve
pulmonary artery
pulmonary vein
right atrium
right ventricle
superior vena cava
tricuspid valve
783
CHAPTER 12
784
Respiratory System
CHAPTER SECTIONS:
Introduction 432
Anatomy and Physiology of Respiration 432
Vocabulary 436
Terminology 437
Pathology 443
Clinical Procedures 450
Abbreviations 455
Practical Applications 457
In Person: Recurrent Pneumonia 458
Exercises 459
Answers to Exercises 466
Pronunciation of Terms 468
Review Sheet 471
CHAPTER GOALS
• Name the organs of the respiratory system and their location and function.
• Identify pathologic conditions that affect the respiratory system.
• Learn medical terms that pertain to respiration.
• Describe important clinical procedures related to the respiratory system, and recognize
relevant abbreviations.
• Apply your new knowledge to understanding medical terms in their proper contexts, such as
medical reports and records.
785
786
Introduction
We usually think of respiration as the mechanical process of breathing, the exchange
of air between the lungs and the external environment. This exchange of air at the
lungs is called external respiration. During inhalation, oxygen passes from the
environment (inhaled air contains about 21%) into the lung air sacs and blood
capillaries of lungs. Simultaneously, during exhalation carbon dioxide, a gas waste
product produced when oxygen and food combine in cells, passes from the capillary
blood vessels into the air sacs of the lungs to be exhaled.
Whereas external respiration occurs between the outside environment and the
capillary blood of the lungs, another form of respiration occurs between the individual
body cells and the tiny capillary blood vessels that surround them. This is internal
(cellular) respiration, which involves an exchange of gases at the level of the cells
within all organs of the body. Here, oxygen passes out of the tissue capillaries into
body cells. At the same time, carbon dioxide passes from body cells into the tissue
capillaries to travel to the lungs for exhalation. See Figure 12-1.
FIGURE 12-1
787
Anatomy and Physiology of Respiration
Label Figure 12-2 as you read the following paragraphs that describe the respiratory
organs and their functions.
FIGURE 12-2 Organs of the respiratory system.
Air enters the body via the nose [1] through two openings called nostrils or nares.
Air then passes through the nasal cavity [2], lined with a mucous membrane and fine
hairs (cilia) to help filter out foreign bodies, as well as to warm and moisten the air.
Paranasal sinuses [3] are hollow, air-containing spaces within the skull that
communicate with the nasal cavity. They, too, have a mucous membrane lining.
Besides producing mucus, a lubricating fluid, the sinuses lighten the bones of the skull
and help produce sound.
After passing through the nasal cavity, the air next reaches the pharynx (throat).
There are three divisions of the pharynx. The first is the nasopharynx [4]. It contains
the pharyngeal tonsils, or adenoids [5], which are collections of lymphatic tissue.
They are more prominent in children and, if enlarged, can obstruct air passageways.
Below the nasopharynx and closer to the mouth is the second division of the pharynx,
the oropharynx [6]. The palatine tonsils [7], two rounded masses of lymphatic tissue,
are in the oropharynx. The third division of the pharynx, the laryngopharynx [8],
788
serves as a common passageway for food from the mouth and air from the nose. It
divides into the larynx (voice box) [9] and the esophagus [10].
The esophagus leads into the stomach and carries food to be digested. The larynx
contains the vocal cords and is surrounded by pieces of cartilage for support and to
keep the airway open. The thyroid cartilage is the largest and in men is commonly
referred to as the Adam's apple. As expelled air passes the vocal cords, they vibrate to
produce sounds. The tension of the vocal cords determines the high or low pitch of the
voice.
Because food entering from the mouth and air entering from the nose mix in the
pharynx, what prevents food or drink from entering the larynx and respiratory system
during swallowing? Even if a small quantity of solid or liquid ma er finds its way into
the air passages, aspirated food can cause irritation in the lungs and breathing can
stop. The epiglo is [11], a flap of cartilage a ached to the root of the tongue, prevents
choking or aspiration of food. It acts as a lid over the opening of the larynx. During
swallowing, when food and liquid move through the throat, the epiglo is closes over
the larynx, preventing material from entering the lungs. Figure 12-3 shows the larynx
from a superior view.
FIGURE 12-3 The larynx, viewed from above (superior view).
On its way to the lungs, air passes through the larynx to the trachea (windpipe) [12],
a vertical tube about
inches long and 1 inch in diameter. The trachea is kept open
by 16 to 20 C-shaped rings of cartilage separated by fibrous connective tissue that
stiffen the front and sides of the tube.
The mediastinum [13] is a space in the center of the chest. In the region of the
mediastinum, the trachea divides into two branches, the right and left bronchial tubes,
or bronchi [14] (singular: bronchus). The bronchi are tubes composed of delicate
epithelium surrounded by cartilage rings and a muscular wall. Each bronchus leads to
a separate lung [15], where it divides and subdivides into smaller and finer tubes,
somewhat like the branches of a tree.
The small bronchial branches are the bronchioles. Each terminal bronchiole [16]
narrows into alveolar ducts, which end in collections of air sacs called alveoli [17]
(singular: alveolus). About 300 million alveoli are estimated to be present in both
lungs. The total area of the alveoli is approximately the size of a tennis court. Each
alveolus is lined with a one-cell-thick layer of epithelium. This very thin wall permits
an exchange of gases between the alveolus and the capillary [18] surrounding it. Blood
flowing through the capillary accepts oxygen from the alveolus while depositing
carbon dioxide into the alveolus. Erythrocytes [19] in the blood carry oxygen away
from the lungs to all parts of the body and carbon dioxide back to the lungs for
exhalation.
789
Each lung is covered by a double-layered membrane called the pleura. The outer
layer of this membrane, nearer the ribs, is the parietal pleura [20], and the inner layer,
closer to the lung, is the visceral pleura [21]. A serous (thin, watery fluid) secretion
moistens the pleura and facilitates movements of the lungs within the chest (thorax).
The two lungs are not quite mirror images of each other. The slightly larger right
lung is divided into three lobes, whereas the smaller left lung has two lobes. One lobe
of the lung can be removed without significantly compromising lung function. The
uppermost part of the lung is the apex, and the lower area is the base. The hilum of
the lung is the midline region in which blood vessels, nerves, lymphatic tissue, and
bronchial tubes enter and exit.
The lungs extend from the collarbone to the diaphragm [22] in the thoracic cavity.
The diaphragm is a muscular partition separating the thoracic from the abdominal
cavity and aiding in the process of breathing. It contracts and descends with each
inhalation (inspiration) and relaxes and ascends with each exhalation (expiration).
The downward movement of the diaphragm enlarges the area in the thoracic cavity,
decreasing internal air pressure, so that air flows into the lungs to equalize the
pressure. When the lungs are full, the diaphragm relaxes and elevates, making the area
in the thoracic cavity smaller, thus increasing air pressure in the chest. Air then is
expelled out of the lungs to equalize the pressure; this is exhalation (expiration).
Figure 12-4 shows the position of the diaphragm in inspiration and in expiration.
FIGURE 12-4 Position of the diaphragm during inhalation (inspiration) and
exhalation (expiration).
Figure 12-5 is a flow diagram of the pathway of air from the nose, where air enters
the body, to the capillaries of the lungs, where oxygen enters the bloodstream.
790
FIGURE 12-5 Pathway of air from the nose to the capillaries of the lungs.
Vocabulary
This list reviews terminology introduced in the preceding section. Short definitions
and additional information will reinforce your understanding. Refer to the
Pronunciation of Terms on page 468 for help with difficult or unfamiliar words.
791
adenoids
alveolus
(plural:
alveoli)
apex of the
lung
base of the
lung
bronchioles
bronchus
(plural:
bronchi)
carbon
dioxide
(CO2)
cilia
Lymphatic tissue in the nasopharynx; pharyngeal tonsils.
Air sac in the lung.
Tip or uppermost portion of the lung. An apex is the tip of a structure. Apical means pertaining
to or located at the apex.
Lower portion of the lung; from the Greek basis, foundation. Basilar means located at or in the
base.
Smallest branches of the bronchi. Terminal bronchioles lead to alveolar ducts.
Branch of the trachea (windpipe) that is a passageway into the lung; bronchial tube.
Gas produced by body cells when oxygen and carbon atoms from food combine; exhaled
through the lungs.
Thin hairs a ached to the mucous membrane epithelium lining the respiratory tract. They clear
bacteria and foreign substances from the lung. Cigare e smoke impairs the function of cilia.
diaphragm
Muscle separating the chest and abdomen. It contracts to pull air into the lungs and relaxes to
push air out.
epiglo is
Lid-like piece of cartilage that covers the larynx, preventing food from entering the larynx and
trachea during swallowing.
exhalation
Breathing out; expiration.
glo is
Slit-like opening to the larynx.
hilum of the Midline region where the bronchi, blood vessels, and nerves enter and exit the lungs. Hilar
lung
means pertaining to (at) the hilum.
inhalation
Breathing in; inspiration.
larynx
Voice box; containing the vocal cords.
lobe
Division of a lung.
mediastinum Region between the lungs in the chest cavity. It contains the trachea, heart, lymph nodes, major
blood vessels, esophagus, and bronchial tubes.
nares
Openings through the nose carrying air into the nasal cavities; nostrils.
oxygen (O2) Gas that makes up 21 percent of the air that we breathe. It passes into the bloodstream at the
lungs and travels to all body cells.
palatine
One of a pair of almond-shaped masses of lymphatic tissue in the oropharynx (palatine means
tonsil
pertaining to the roof of the mouth).
paranasal
One of the air cavities in the bones near the nose.
sinus
parietal
Outer layer of pleura lying closer to the ribs and chest wall.
pleura
pharynx
Throat; including the nasopharynx, oropharynx, and laryngopharynx.
pleura
Double-layered membrane surrounding each lung.
pleural
Space between the layers of the pleura.
cavity
pulmonary
Essential parts of the lung, responsible for respiration; bronchioles and alveoli.
parenchyma
respiration
Exchange of gases (oxygen and carbon dioxide) at the lung capillaries (external respiration or
breathing) and at the tissue capillaries (internal respiration).
trachea
Windpipe.
visceral
Inner layer of pleura lying closer to the lung tissue.
pleura
Terminology
Write the meanings of the medical terms in the spaces provided.
Combining Forms
792
COMBINING
MEANING
FORM
adenoid/o
adenoids
alveol/o
bronch/o
bronchi/o
bronchiol/o
capn/o
coni/o
cyan/o
epiglo /o
laryng/o
lob/o
mediastin/o
nas/o
orth/o
ox/o
pector/o
pharyng/o
phon/o
phren/o
pleur/o
alveolus, air
sac
bronchial
tube,
bronchus
bronchiole,
small
bronchus
carbon
dioxide
dust
TERMINOLOGY
MEANING
adenoidectomy __________________________________
adenoid hypertrophy __________________________________
alveolar __________________________________
bronchospasm __________________________________
This tightening of the bronchi and smaller bronchial tubes (bronchioles) is a chief
characteristic of bronchitis.
bronchiectasis __________________________________
Caused by weakening of the bronchial wall from infection.
bronchodilator __________________________________
This drug causes dilation, or enlargement, of the opening of a bronchus or
bronchiole to improve ventilation to the lungs. An example is albuterol, delivered
via an inhaler.
bronchopleural __________________________________
A bronchopleural fistula is an abnormal connection between the bronchial tube
and the pleural cavity (space). Occurring as a result of lung disease or surgical
complication, this can cause an air leak into the pleural space.
bronchiolitis __________________________________
This is an acute viral infection occurring in infants younger than 18 months of age.
hypercapnia __________________________________
pneumoconiosis __________________________________
See page 447.
blue
cyanosis __________________________________
Caused by deficient oxygen in the blood.
epiglo is
epiglo itis __________________________________
Characterized by fever, sore throat, and an erythematous, swollen epiglo is.
larynx, voice
laryngeal __________________________________
box
laryngospasm __________________________________
Spasm of laryngeal muscles that closes the larynx.
laryngitis
lobe of the
lobectomy __________________________________
lung
Figure 12-6 shows four different types of pulmonary resections.
mediastinum
mediastinoscopy __________________________________
An endoscope is inserted through an incision in the chest.
nose
paranasal sinuses __________________________________
Para- means near in this term. See Figure 12-7.
nasogastric intubation __________________________________
straight,
orthopnea __________________________________
upright
An abnormal condition in which breathing (-pnea) is easier in the upright position.
A major cause of orthopnea is congestive heart failure. Physicians assess the degree
of orthopnea by the number of pillows a patient requires to sleep comfortably (e.g.,
two-pillow orthopnea).
oxygen
hypoxia __________________________________
Tissues have a decreased amount of oxygen, and cyanosis can result.
chest
expectoration __________________________________
Clearing of secretions from the airway by coughing or spi ing. This sputum can
contain mucus, blood, cellular debris, pus, and microorganisms.
pharynx,
pharyngeal __________________________________
throat
voice
dysphonia __________________________________
Hoarseness or other voice impairment.
diaphragm
phrenic nerve __________________________________
The motor nerve to the diaphragm.
pleura
pleurodynia __________________________________
The suffix -dynia means pain. The intercostal muscles or pleura are inflamed,
causing pain during breathing.
pleural effusion __________________________________
An effusion is the escape of fluid from blood vessels or lymphatics into a cavity or
into tissue spaces.
793
COMBINING
MEANING
FORM
pneum/o,
air, lung
pneumon/o
pulmon/o
rhin/o
sinus/o
spir/o
tel/o
thorac/o
tonsill/o
trache/o
TERMINOLOGY
MEANING
pneumothorax __________________________________
The suffix -thorax means chest. Because of a hole in the lung, air accumulates in the
pleural cavity, between the layers of the pleura (Figure 12-8).
pneumonectomy __________________________________
pulmonary __________________________________
The pulmonary circulation carries oxygen-poor (deoxygenated) blood from the
heart to the lungs and then returns oxygenated blood back to the heart for
transportation throughout the body.
nose
rhinoplasty __________________________________
rhinorrhea __________________________________
Commonly known as “runny nose.”
sinus, cavity sinusitis __________________________________
breathing
spirometer __________________________________
expiration __________________________________
Note that the s is omi ed (when it's preceded by an x).
respiration __________________________________
Cheyne-Stokes respirations are marked by rhythmic changes in the depth of
breathing (rapid breathing and then absence of breathing). The pa ern occurs every
45 seconds to 3 minutes. The cause may be heart failure or brain damage, both of
which affect the respiratory center in the brain.
complete
atelectasis __________________________________
Collapsed lung; incomplete expansion (-ectasis) of a lung (Figure 12-9). Atelectasis
may occur after surgery when a patient experiences pain and does not take deep
breaths, preventing full expansion of the lungs.
chest
thoracotomy __________________________________
thoracic __________________________________
tonsils
tonsillectomy __________________________________
The oropharyngeal (palatine) tonsils are removed.
trachea,
tracheotomy __________________________________
windpipe
tracheal stenosis __________________________________
Injury to the trachea from trauma, a burn, or serious infection can cause scarring
and contraction that obstructs the flow of air. For example, having an endotracheal
tube in place for a prolonged period may lead to tracheal injury or the formation of
scar tissue.
lung
794
FIGURE 12-6 Pulmonary resections. A, Wedge resection is the removal of a
small, localized area of diseased tissue near the surface of the lung. Pulmonary
function and structure are relatively unchanged after healing. B, Segmental
resection is the removal of a bronchiole and its alveoli (one or more lung
segments). The remaining lung tissue expands to fill the previously occupied
space. C, Lobectomy is the removal of an entire lobe of the lung. After lobectomy,
the remaining lung increases in size to fill the space in the thoracic cavity. D,
Pneumonectomy is the removal of an entire lung. Techniques such as removal of
ribs and elevation of the diaphragm are used to reduce the size of the empty
thoracic space.
795
FIGURE 12-7 Paranasal sinuses. These are 4-paired, air-filled spaced in the
bones of the skull surrounding the nasal cavity. Sinusitis is inflammation of the
paranasal sinuses due to viral, bacterial, or fungal infections or allergic reactions.
FIGURE 12-8 Pneumothorax. Air gathers in the pleural cavity, causing the lung
to collapse. When this happens, the lung cannot fill up with air, breathing becomes
more difficult, and the body gets less oxygen. Onset of pneumothorax is marked by
sudden, sharp chest pain with difficulty breathing.
796
FIGURE 12-9 Two forms of atelectasis. A, Bronchial obstruction prevents air
from reaching distal airways, and alveoli collapse. The most frequent cause is
blockage of a bronchus by a mucous or mucopurulent (pus-containing) plug, as
might occur postoperatively. B, Accumulations of fluid, blood, or air within the
pleural cavity collapse the lung. This can occur with congestive heart failure
(poor circulation leads to fluid buildup in the pleural cavity), pneumonia, trauma, or
a pneumothorax.
Suffixes
SUFFIX MEANING TERMINOLOGY
MEANING
-ema
condition
empyema ______________________________________
Em- at the beginning of this term means in. Empyema (pyothorax) is a collection of pus in
the pleural cavity.
-osmia smell
anosmia ______________________________________
-pnea
breathing
apnea ______________________________________
Sleep apnea is sudden cessation of breathing during sleep. It can result in hypoxia, leading
to cognitive impairment, hypertension, and arrhythmias. Obstructive sleep apnea (OSA)
involves narrowing or occlusion in the upper airway. Continuous positive airway
pressure (CPAP) is gentle ventilatory support used to keep the airways open (Figure 1210).
dyspnea ______________________________________
Dys- means abnormal here and is associated with shortness of breath (SOB). Paroxysmal
(sudden) nocturnal (at night) dyspnea may be experienced by patients with congestive
heart failure when they recline in bed. Patients often describe the sensation as “air hunger.”
hyperpnea ______________________________________
An increase in the depth of breathing, occurring normally with exercise and abnormally
with any condition in which the supply of oxygen is inadequate.
tachypnea ______________________________________
Tachy- means fast. Excessively rapid and shallow breathing; hyperventilation.
-ptysis spi ing
hemoptysis ______________________________________
Blood is coughed up from the bronchial tubes and lungs; occurs with bronchitis or
pneumonia, but also with tuberculosis, cancer, bronchiectasis, and pulmonary embolism.
pulse
asphyxia ______________________________________
sphyxia
This condition, literally meaning lack of pulse, is severe hypoxia leading to hypoxemia,
hypercapnia, loss of consciousness, and death.
-thorax pleural
hemothorax ______________________________________
cavity,
pyothorax ______________________________________
chest
Empyema of the chest.
797
FIGURE 12-10 This man is sleeping with a nasal CPAP (continuous positive
airway pressure) mask in place. The pressure supplied by air coming from the
compressor opens the oropharynx and nasopharynx.
798
Pathology
Diagnostic terms
auscultation
percussion
pleural rub
rales
(crackles)
rhonchi
(singular:
rhonchus)
sputum
stridor
wheezes
Listening to sounds within the body.
This procedure, performed with a stethoscope, is used chiefly for listening to the passage of
air into and out of the lungs and listening to heart sounds. It is helpful to diagnose
conditions of the lungs, pleura, heart, and abdomen, as well as to determine the condition of
the fetus during pregnancy.
Tapping on a surface to determine the difference in the density of the underlying
structure.
Tapping over a solid organ produces a dull sound without resonance. Percussion over an
air-filled structure, such as the lung, produces a resonant, hollow note. When the lungs or
the pleural space are filled with fluid and become more dense, as in pneumonia, resonance is
replaced by dullness.
Scratchy sound produced by pleural surfaces rubbing against each other.
Pleural rub (also called a friction rub) occurs when the pleurae are roughened and thickened
by inflammation, infection, scarring, or neoplastic cells. It is heard on auscultation and can
be felt by placing the fingers on the chest wall.
Fine crackling sounds heard on auscultation (during inhalation) when there is fluid in the
alveoli.
These popping or clicking sounds can be heard in patients with pneumonia, bronchiectasis,
or acute bronchitis. The French word rale means ra le.
Loud rumbling sounds heard on auscultation of bronchi obstructed by sputum.
These coarse rumbling sounds resemble snoring and are usually caused by secretions in
larger bronchial tubes.
Material expelled from the bronchi, lungs, or upper respiratory tract by spi ing.
Purulent (containing pus) sputum often is green or brown. It results from infection and may
be seen with asthma. Blood-tinged sputum is suggestive of tuberculosis or malignancy. For a
sputum culture, the specimen is maintained in a nutrient medium to promote growth of a
pathogen. Culture and sensitivity (C&S) testing identifies the sputum pathogen and
determine which antibiotic will be effective in destroying or reducing its growth.
Strained, high-pitched sound heard on inspiration caused by obstruction in the pharynx
or larynx.
Common causes of stridor include throat abscess, airway injury, croup, allergic reaction, or
epiglo itis and laryngitis.
Continuous high-pitched whistling sounds produced during breathing.
Wheezes are heard when air is forced through narrowed or obstructed airways. Patients
with asthma or emphysema commonly experience wheezing as bronchi narrow and tighten.
Upper Respiratory Disorders
799
croup
diphtheria
epistaxis
pertussis
Acute viral infection of infants and children with obstruction of the larynx, accompanied
by barking cough and stridor.
The most common causative agents are influenza viruses or respiratory syncytial virus (RSV).
Acute infection of the throat and upper respiratory tract caused by the diphtheria bacterium
(Corynebacterium).
Inflammation occurs, and a leathery, opaque membrane (Greek diphthera, leather membrane)
forms in the pharynx and trachea.
Immunity to diphtheria (by production of antibodies) is induced by the administration of
weakened toxins (antigens) beginning between the sixth and eighth weeks of life. These
injections usually are given as combination vaccines with pertussis and tetanus toxins and so
are called DPT injections.
Nosebleed.
Epistaxis is a Greek word meaning a dropping. It commonly results from irritation of nasal
mucous membranes, trauma, vitamin K deficiency, clo ing abnormalities, blood-thinning
medications (such as aspirin and warfarin), or hypertension.
Whooping cough; highly contagious bacterial infection of the pharynx, larynx, and trachea
caused by Bordetella pertussis.
Pertussis is characterized by paroxysmal (violent, sudden) spasms of coughing that ends in a
loud “whooping” inspiration.
Bronchial Disorders
asthma
Chronic inflammatory disorder with airway obstruction due to bronchial and
bronchiolar edema and constriction.
Associated signs and symptoms of asthma are dyspnea, wheezing, increased mucus
production, and cough. Etiology can involve allergy or infection. Triggers for asthmatic
a acks include exercise, strong odors, cold air, stress, allergens (e.g., tobacco smoke, pet
dander, dust, molds, pollens, foods), and medications (aspirin, beta blockers).
Asthma treatments are:
• Fast-acting agents for acute symptoms; example is an albuterol inhaler (bronchodilator).
• Long-acting agents for long-term control; examples are glucocorticoids (inhaled), oral
steroids (anti-inflammatory drugs), and leukotriene blockers such as montelukast
(Singulair).
Other conditions, such as gastroesophageal reflux disease (GERD), sinusitis, and allergic
rhinitis, can exacerbate asthma.
bronchiectasis
Chronic dilation of a bronchus, usually secondary to infection.
This condition is caused by chronic infection with loss of elasticity of the bronchi.
Secretions puddle and do not drain normally. Signs and symptoms are cough, fever, and
expectoration of foul-smelling, purulent (pus-containing) sputum. Treatment is palliative
(noncurative) and includes antibiotics, mucolytics, bronchodilators, respiratory therapy,
and surgical resection if other therapies are not effective.
chronic
Inflammation of bronchi persisting over a long time; type of chronic obstructive
bronchitis
pulmonary disease (COPD).
Infection and cigare e smoking are etiologic factors. Signs and symptoms include
excessive secretion of often infected mucus, a productive cough, and obstruction
of respiratory passages. Chronic bronchitis and emphysema (lung disease in which air
exchange at the alveoli is severely impaired) are types of chronic obstructive pulmonary
disease (COPD).
cystic fibrosis
Inherited disorder of exocrine glands resulting in thick mucinous secretions in the
(CF)
respiratory tract that do not drain normally.
This is a genetic disorder caused by a mutation in a gene. It can be diagnosed by newborn
screening blood test, sweat test, and genetic testing. CF affects the epithelium (lining cells)
of the respiratory tract, leading to chronic airway obstruction, infection, bronchiectasis,
and sometimes respiratory failure. It also involves exocrine glands, such as the pancreas
(insufficient secretion of digestive enzymes leads to poor growth) and sweat glands (salty
tasting skin). There is no known cure, but therapy includes antibiotics, aerosolized
medications, chest physiotherapy, and replacement of pancreatic enzymes. A new
medication called ivacaftor (Kalydeco) helps prevent the buildup of thick mucus in the
lungs. Lung transplantation becomes necessary for some patients. It can restore lung
function and prolong life.
Lung Disorders
800
atelectasis
Collapsed lung; incomplete expansion of alveoli, (Figure 12-9, page 441).
In atelectasis, the bronchioles and alveoli (pulmonary parenchyma) resemble a collapsed
balloon.
emphysema
Hyperinflation of air sacs with destruction of alveolar walls (Figure 12-11A and B).
Loss of elasticity and the breakdown of alveolar walls result in expiratory flow
limitation. There is a strong association between cigare e smoking and emphysema. As
a result of the destruction of lung parenchyma, including blood vessels, pulmonary
artery pressure rises and the right side of the heart must work harder to pump blood.
This leads to right ventricular hypertrophy and right heart failure (cor pulmonale).
Emphysema and chronic bronchitis are both forms of COPD.
lung cancer
Malignant tumor arising from the lungs and bronchi (Figure 12-12).
This group of cancers, often associated with cigare e smoking, is the most frequent fatal
malignancy. Lung cancers are divided into two general categories: non–small cell lung
cancer (NSCLC) and small cell lung cancer (SCLC).
NSCLC accounts for 90% of lung cancers and comprises three main types:
adenocarcinoma (derived from mucus-secreting cells), squamous cell carcinoma
(derived from the lining cells of the upper airway), and large cell lung cancer. When
lung cancer is diagnosed, physicians assess the stage of the tumor (determined by its
size, lymph node involvement, and any distant areas of spread) to prepare a protocol for
treatment.
For localized tumors, surgery may be curative. Staging of NSCLC by assessing
mediastinal lymph nodes is critical. If nodes are negative and there are no other medical
problems, the patient is a good candidate for surgery. If nodes are positive,
multimodality treatment (chemotherapy and irradiation), with or without surgery, may
be an option. Doctors treat metastatic disease (to liver, brain, and bones) with palliative
chemotherapy and/or radiation therapy.
In some patients, often nonsmokers, NSCLC may be caused by a mutation (change) in
epithelial lung tissue. An example is a mutation in the epidermal growth factor receptor
(EGFR), which is sensitive to treatment with EGFR inhibitors (Iressa and Tarceva). This
is an example of targeted drug therapy for cancer. Examples of tumors treatable by
interfering with mutated gene products are increasing.
SCLC derives from small, round cells (“oat” cells) found in pulmonary epithelium. It
grows rapidly and quickly spreads outside the lung. Treatment with surgery, radiation
therapy, and/or chemotherapy may lead to remissions.
pneumoconiosis
Abnormal lung condition caused by exposure to certain dusts; with chronic
inflammation, infection, and bronchitis (Figure 12-13A).
Various forms are named according to the type of dust particle inhaled: anthracosis—
coal (anthrac/o) dust (black lung disease); asbestosis—asbestos (asbest/o) particles (in
shipbuilding and construction trades); silicosis—silica (silic/o = rocks) or glass (grinder's
disease).
pneumonia
Acute inflammation and infection of alveoli, which fill with pus or products of the
inflammatory reaction.
Etiologic agents are pneumococci, staphylococci, and other bacteria, fungi, or viruses.
Infection damages alveolar membranes so that an exudate (fluid, blood cells, and debris)
consolidates the alveoli (sacs become “glued” together, making air exchange less
effective). An infiltrate is a fluid-filled area within the lungs as seen on a chest x-ray or
CT scan. Lobar pneumonia (see Figure 12-13B) involves an entire lobe of a lung.
Bronchopneumonia is a limited form of infection that produces patchy consolidation
(abscesses) in the lung parenchyma. Treatment includes appropriate antibiotics and, if
necessary, oxygen and mechanical ventilation in severe cases. See In Person: Recurring
Pneumonia, page 458.
Community-acquired pneumonia results from a contagious respiratory infection,
caused by a variety of viruses and bacteria (including pneumococci and Mycoplasma
bacteria). It usually is treated at home with oral antibiotics.
Hospital-acquired pneumonia or nosocomial pneumonia is acquired during
hospitalization (Greek nosokomeion means hospital). For example, patients may contract
pneumonia while on mechanical ventilation or as a hospital-acquired infection.
Aspiration pneumonia is caused by material, such as food or vomitus, lodging in
bronchi or lungs. It is a danger in the elderly, Alzheimer disease patients, stroke victims,
and people with esophageal reflux and feeding tubes.
X-ray images of a normal chest and one with pneumonia are on page 450.
pulmonary
Large collection of pus (bacterial infection) in the lungs.
abscess
pulmonary
Fluid in the air sacs and bronchioles.
edema
This condition most often is caused by the inability of the heart to pump blood
(congestive heart failure). Blood backs up in the pulmonary blood vessels, and fluid
801
pulmonary
embolism (PE)
pulmonary
fibrosis
sarcoidosis
tuberculosis
(TB)
seeps out into the alveoli and bronchioles. Acute pulmonary edema requires immediate
medical a ention, including drugs (diuretics), oxygen in high concentrations, and
keeping the patient in a si ing position (to decrease venous return to the heart).
Clot or other material lodges in vessels of the lung (Figure 12-14A and B).
The clot (embolus) travels from distant veins, usually in the legs. Occlusion can produce
an area of dead (necrotic) tissue; this is a pulmonary infarction. PE often causes acute
pleuritic chest pain (pain on inspiration) and may be associated with blood in the
sputum, fever, and respiratory insufficiency. CT angiography is the primary diagnostic
tool for pulmonary emboli.
Formation of scar tissue in the connective tissue of the lungs.
This condition can be primary (idiopathic) or secondary as the result of chronic
inflammation or irritation caused by tuberculosis, pneumonia, or pneumoconiosis.
Chronic inflammatory disease in which small nodules (granulomas) develop in lungs,
lymph nodes, and other organs.
The cause of sarcoidosis is unknown. Bilateral hilar lymphadenopathy or lung
involvement is visible on chest x-ray in most cases. Many patients are asymptomatic and
retain adequate pulmonary function. Sarcoidosis may affect the brain, heart, liver, and
other organs. Other patients have more active disease and impaired pulmonary
function. Glucocorticoids are used to prevent progression of the illness.
Infectious disease caused by Mycobacterium tuberculosis; lungs usually are involved,
but any organ in the body may be affected.
Rod-shaped bacteria called bacilli invade the lungs, producing small tubercles (from
Latin tuber, a swelling) of infection. Early TB usually is asymptomatic and detected on
routine chest x-ray studies. Signs and symptoms of advanced disease are cough, weight
loss, night sweats, hemoptysis, and pleuritic pain. Antituberculosis chemotherapy
(isoniazid, rifampin) is effective in most cases. Immunocompromised patients are
particularly susceptible to antibiotic-resistant TB. It is important and often necessary to
treat TB with several drugs at the same time to prevent drug resistance.
The PPD skin test (see page 454) is given to most hospital and medical employees
because TB is highly contagious. A positive PPD test, indicates exposure to TB, and
treatment with isoniazid will be necessary even in the absence of lung infection.
FIGURE 12-11 A, Normal lung tissue. B, Emphysema. Notice the overinflation
of air sacs and destruction of alveolar walls.
802
FIGURE 12-12 Lung cancer. The gray-white tumor tissue is infiltrating the
substance of the lung. This tumor was identified as a squamous cell carcinoma.
Squamous cell carcinomas arise in major bronchi and spread to local hilar lymph
nodes.
FIGURE 12-13 A, Anthracosis or black lung disease. Notice the dark black
deposits of coal dust throughout the lung. B, Lobar pneumonia (at autopsy).
Notice that the condition affects a lobe of the lung. The patient's signs and
symptoms included fever, chills, cough, dark sputum, rapid shallow breathing, and
hypoxia. If diagnosis is made early, antibiotic therapy is successful.
803
FIGURE 12-14 Pulmonary embolism (A and B).
Atelectasis
Common Causes
• Bronchial obstruction—by secretions or tumor
• Complications following surgery—poor breathing ability
• Chest wounds—air (pneumothorax), fluid (pleural effusion), or blood
(hemothorax) accumulate in the pleural cavity
Pleural Disorders
mesothelioma
pleural
effusion
pleurisy
(pleuritis)
pneumothorax
Rare malignant tumor arising in the pleura.
Mesotheliomas are derived from mesothelium, which forms the lining of the pleural
surface. These tumors usually are caused by asbestos exposure.
Abnormal accumulation of fluid in the pleural space (cavity).
Two types of pleural effusions are exudates (fluid from tumors and infections) and
transudates (fluid from congestive heart failure, or cirrhosis).
Inflammation of the pleura.
This condition causes pleurodynia and dyspnea and, in chronic cases, pleural effusion.
Collection of air in the pleural space.
Pneumothorax may occur in the course of a pulmonary disease (emphysema, carcinoma,
tuberculosis, or lung abscess) when a break in the lung surface releases air into the pleural
space. This allows communication between an alveolus or bronchus and the pleural
cavity. It may also follow trauma and perforation of the chest wall or prolonged high-flow
oxygen delivered by a respirator in an intensive care unit (ICU).
Pleurodesis (-desis means to bind) is the artificial production of adhesions between the
parietal and visceral pleura for treatment of persistent pneumothorax and severe pleural
effusion. This is accomplished by using talc powder or drugs, such as antibiotics, that
cause irritation and scarring of the pleura.
Study Section
Practice spelling each term and know its meaning.
804
anthracosis
asbestosis
bacilli
(singular:
bacillus)
chronic
obstructive
pulmonary
disease
(COPD)
cor
pulmonale
exudates
Coal dust accumulates in the lungs.
Asbestos particles accumulate in the lungs.
Rod-shaped bacteria.
Chronic condition of persistent obstruction of air flow through bronchial tubes and lungs. COPD
is caused by smoking, air pollution, chronic infection, and, in a minority of cases, asthma.
Patients with predominant chronic bronchitis COPD may be referred to as “blue bloaters”
(cyanotic, stocky build), whereas those with predominant emphysema may be called “pink
puffers” (short of breath, but with near-normal blood oxygen levels, and no change in skin color).
Failure of the right side of the heart to pump a sufficient amount of blood to the lungs because of
underlying lung disease.
Fluid, cells, and other substances (pus) that filter from cells or capillaries ooze into lesions or
areas of inflammation.
infiltrate
Collection of fluid or other material within the lung, as seen on a chest film, CT scan, or other
radiologic image.
palliative
Relieving symptoms, but not curing the disease.
paroxysmal Pertaining to a sudden occurrence, such as a spasm or seizure; oxysm/o means sudden.
pulmonary Area of necrosis (death of lung tissue).
infarction
purulent
Containing pus.
silicosis
Disease due to silica or glass dust in the lungs; occurs in mining occupations.
805
Clinical Procedures
X-Ray Tests
chest x-ray
(CXR)
computed
tomography
(CT) scan of the
chest
Radiographic image of the thoracic cavity (chest film).
Chest x-rays are taken in the frontal (coronal) plane as posteroanterior (PA) or
anteroposterior (AP) views and in the sagi al plane as lateral views. Figure 12-15A and
B shows a normal chest film and an x-ray film of the chest with pneumonia.
Computer-generated series of x-ray images show thoracic structures in cross section
and other planes.
This test is for diagnosis of lesions difficult to assess by conventional x-ray studies, such
as those in the lungs, mediastinum, and pleura.
CT pulmonary angiography (CTPA) is the combination of CT scanning and
angiography. It is useful to examine the pulmonary circulation in the diagnosis of a
pulmonary embolism.
FIGURE 12-15 A, A normal chest x-ray appearance. The image is taken from
the posteroanterior (PA) view (x-ray passes from back to front). The backward L
in the upper corner is placed on the film to indicate the left side of the patient's
chest. A, Diaphragm; B, costophrenic angle; C, left ventricle of the heart; D, right
atrium of the heart; E, aortic arch; F, superior vena cava; G, trachea. Air-filled lung
spaces appear black. B, Pneumonia of the right lung shown on an x-ray image of
the chest.
Magnetic Resonance Imaging
magnetic resonance imaging
(MRI) of the chest
Magnetic waves create detailed images of the chest in frontal, lateral
(sagi al), and cross-sectional (axial) planes.
This test is helpful in defining mediastinal tumors (such as those of
Hodgkin disease) difficult to assess by CT scan.
Nuclear Medicine Tests
806
positron
emission
tomography
(PET) scan of the
lung
ventilationperfusion (V/Q)
scan
Radioactive glucose is injected, and images reveal metabolic activity in the lungs.
This scanning technique can identify malignant tumors, which have higher metabolic
activity. It is also used to assess small nodules seen on a CT scan.
Detection device records radioactivity in the lung after intravenous injection of a
radioisotope and inhalation of a small amount of radioactive gas (xenon).
This test can identify areas of the lung not receiving adequate air flow (ventilation) or
blood flow (perfusion) as well as areas where there is a mismatch in air flow (V) and
blood flow (Q). Air flow without matched blood flow suggests a pulmonary embolus.
Other Procedures
807
bronchoscopy
Fiberoptic endoscope examination of the bronchial tubes.
A physician places the bronchoscope through the throat, larynx, and trachea into the
bronchi for diagnosis, biopsy, or collection of secretions. In bronchoalveolar lavage
(bronchial washing), fluid is injected and withdrawn. In bronchial brushing, a brush is
inserted through the bronchoscope and is used to scrape off tissue (Figure 12-16).
Endobronchial ultrasound (EBUS) is performed during bronchoscopy to diagnose and
stage lung cancer. An EBUS-guided biopsy allows for sampling of small (<3 cm)
peripheral lesions endoscopically.
endotracheal
Placement of a tube through the mouth into the pharynx, larynx, and trachea to
intubation
establish an airway (Figure 12-17).
This procedure also allows the patient to be placed on a mechanical ventilator (an
apparatus that moves air into and out of the lungs).
laryngoscopy
Visual examination of the voice box.
A lighted, flexible endoscope is passed through the mouth or nose into the larynx.
lung biopsy
Removal of lung tissue followed by microscopic examination.
Specimens may be obtained by bronchoscopy, thoracotomy (open-lung biopsy), needle
biopsy through the chest wall, or video-assisted thoracoscopic surgery (VATS).
mediastinoscopy
Endoscopic visual examination of the mediastinum.
An incision is made above the breastbone (suprasternal) for inspection and biopsy of
lymph nodes in the underlying space (mediastinum).
pulmonary
Tests that measure the ventilation mechanics of the lungs: airway function, lung
function tests
volume, and the capacity of the lungs to exchange oxygen and carbon dioxide
(PFTs)
efficiently. See Figure 12-18.
PFTs are used for many reasons: (1) to evaluate patients with shortness of breath (SOB);
(2) to monitor lung function in patients with known respiratory disease; (3) to evaluate
disability; and (4) to assess lung function before surgery. A spirometer measures the
volume and rate of air passing into and out of the lung.
PFTs determine if lung disease is obstructive, restrictive, or both. In obstructive lung
disease, airways are narrowed, which results in resistance to air flow during breathing.
A hallmark PFT abnormality in obstructive disease is decreased expiratory flow rate or
FEV1 (forced expiratory volume in the first second of expiration). Examples of
obstructive lung diseases are asthma, COPD, bronchiectasis, cystic fibrosis, and
bronchiolitis.
In restrictive lung disease, expansion of the lung is limited by disease that affects the
chest wall, pleura, or lung tissue itself. A hallmark PFT abnormality in restrictive
disease is decreased total lung capacity (TLC). Examples of lung conditions that stiffen
and scar the lung are pulmonary fibrosis, radiation damage to the lung, and
pneumoconiosis. Other causes of restrictive lung disease are neuromuscular conditions
that affect the lung, such as myasthenia gravis, muscular dystrophy, and diaphragmatic
weakness and paralysis.
The ability of gas to diffuse across the alveolar-capillary membrane is assessed by
determining the diffusion capacity of the lung for carbon monoxide (DLCO). A patient
breathes in a small amount of carbon monoxide (CO), and the length of time it takes the gas
to enter the bloodstream is measured. A common cause of reduced DLCO is emphysema
due to destruction of alveoli.
thoracentesis
Needle is inserted into pleural space to remove excess fluid.
This minimally invasive procedure is used to obtain pleural fluid for diagnosis or to
therapeutically drain a pleural effusion (Figure 12-19). The suffix -centesis means
puncture with a needle.
thoracotomy
Large surgical incision of the chest.
The incision is large, cu ing into bone, muscle, and cartilage. It is necessary for major
resections of the lung (lobectomy and pneumonectomy).
thoracoscopy
Visual examination of the chest via small incisions and use of an endoscope.
(thorascopy)
Video-assisted thoracic surgery (VATS) allows the surgeon to view the chest from a
video monitor. The thorascope (thoracoscope) is equipped with a camera that magnifies
the image on the monitor. Thoracoscopy can diagnose and treat conditions of the lung,
pleura, and mediastinum.
tracheostomy
Surgical creation of an opening into the trachea through the neck.
A tube is inserted to create an airway. The tracheostomy tube may be permanent as well
as an emergency device (Figure 12-20). A tracheotomy is the incision necessary to create
a tracheostomy.
tuberculin test
Determines past or present tuberculous exposure based on a positive skin reaction.
Examples are the Heaf test and the tine test, using purified protein derivative (PPD)
applied with multiple punctures of the skin, and the Mantoux test, using PPD given by
intraepidermal injection.
tube
Flexible, plastic chest tube is passed into the pleural space through an opening in the
808
thoracostomy
chest.
This procedure is used to continuously remove air (pneumothorax), fluid (pleural
effusion), blood (hemothorax), pus (empyema). See Figure 12-21.
FIGURE 12-16 A, Fiberoptic bronchoscopy. A bronchoscope is passed through
the nose, throat, larynx, and trachea into a bronchus. B, A bronchoscope, with
brush catheter, in place in a bronchial tube.
FIGURE 12-17 Endotracheal intubation. The patient is in a supine position; the
head is hyperextended, the lower portion of the neck is flexed, and the mouth is
opened. A laryngoscope is used to hold the airway open, to expose the vocal
cords, and as a guide for placing the tube into the trachea.
809
FIGURE 12-18 An individual undergoing a pulmonary function test.
FIGURE 12-19 Thoracentesis. A, The patient is sitting in the correct position for
the procedure; it allows the chest wall to be pulled outward in an expanded
position. B, The needle is inserted close to the base of the effusion so that gravity
can help with drainage, but it is kept as far away from the diaphragm as possible.
The needle is inserted above the appropriate rib to avoid the neurovascular
structures that run beneath each rib.
810
FIGURE 12-20 A, Tracheostomy tube in place. B, Healed tracheostomy after
laryngectomy.
FIGURE 12-21 A, Tube thoracostomy. B, A patient with two thoracostomy
tubes draining a pleural effusion from two different areas of the chest.
Abbreviations
811
ABGs
AFB
ARDS
BAL
Bronch
CF
CO2
COPD
arterial blood gases
acid-fast bacillus—the type of organism that causes tuberculosis
acute respiratory distress syndrome—severe, sudden lung injury caused by acute illness
bronchoalveolar lavage
bronchoscopy
cystic fibrosis
carbon dioxide
chronic obstructive pulmonary disease—airway obstruction associated with emphysema and chronic
bronchitis
CPAP continuous positive airway pressure
CPR
cardiopulmonary resuscitation—three basic steps (CAB): C, circulation restored by external cardiac
compression; A, airway opened by tilting the head; B, breathing restored by mouth-to-mouth
breathing
C&S
culture and sensitivity testing (of sputum)
CTPA computed tomography pulmonary angiogram
CT-PE Chest CT for pulmonary emboli
CXR
chest x-ray [film]
DLCO diffusion capacity of the lung for carbon monoxide
DOE
dyspnea on exertion
DPT
diphtheria, pertussis, tetanus—toxoids for vaccination of infants, to provide immunity to these
diseases
EBUS endobronchial ultrasound
FEV1
forced expiratory volume in 1 second
FVC
forced vital capacity—amount of gas that can be forcibly and rapidly exhaled after a full inspiration
ICU
intensive care unit
LLL
left lower lobe (of lung)
LUL
left upper lobe (of lung)
MAC
Mycobacterium avium complex—the cause of a noncontagious lung infection related to tuberculosis
MDI
metered-dose inhaler—used to deliver aerosolized medications to patients
NSCLC non–small cell lung cancer
O2
oxygen
OSA
obstructive sleep apnea
PaCO2 carbon dioxide partial pressure—measure of the amount of carbon dioxide in arterial blood
PaO2
oxygen partial pressure—a measure of the amount of oxygen in arterial blood
PCP
Pneumocystis pneumonia—a type of pneumonia seen in patients with AIDS or other
immunosuppression
PE
pulmonary embolism
PEP
positive expiratory pressure—mechanical ventilator strategy in which the patient takes a deep breath
and then exhales through a device that resists air flow (helps refill underventilated areas of the lung)
PEEP
positive end-expiratory pressure—common mechanical ventilator se ing in which airway pressure is
maintained above atmospheric pressure
PFTs
pulmonary function tests
PND
paroxysmal nocturnal dyspnea
PPD
purified protein derivative—substance used in a tuberculosis test
RDS
respiratory distress syndrome—in the newborn infant; marked by dyspnea and cyanosis and related
to absence of surfactant (lubricating substance that permits normal expansion of lungs); also called
hyaline membrane disease
RLL
right lower lobe (of lung)
RML
right middle lobe (of lung)
RSV
respiratory syncytial virus—common cause of bronchiolitis, bronchopneumonia, and the common
cold, especially in children (in tissue culture, forms syncytia or giant cells, so that cytoplasm flows
together)
RUL
right upper lobe (of lung)
RV
residual volume—amount of air remaining in lungs at the end of maximal expiration
SABA short-acting beta agonist (for relief of asthma symptoms)
SCLC small cell lung cancer
SOB
shortness of breath
TB
tuberculosis
TLC
total lung capacity—volume of gas in the lungs at the end of maximal inspiration; equals VC plus RV
URI
upper respiratory infection
VT
tidal volume—amount of air inhaled and exhaled during a normal ventilation
VATS video-assisted thoracic surgery (thoracoscopy)
VC
vital capacity—the maximum volume of air expelled from the lung after taking the deepest possible
812
V/Q
scan
breath
ventilation-perfusion scan—radioactive test of lung ventilation and blood perfusion throughout the
lung capillaries (lung scan)
Practical Applications
Case Study: Targeted Therapy for Lung Cancer
In 2008, Sarah Broom was a 35-year-old literature instructor and poet living in New
Zealand. Married with two young sons, she was pregnant with her third child when
she noticed shortness of breath accompanied by a persistent cough. An x-ray of her
lungs during her 7th month of pregnancy showed a large mass in one lung. After a
cesarean section (her daughter was born safely), she had a biopsy and other tests,
which revealed NSCLC-advanced lung cancer. Sarah was a nonsmoker.
The doctors in New Zealand told her that her care would be palliative and that she
had only a few months to live.
Sarah was desperate to explore every option, and through a personal connection,
she sent her biopsy slides to the MGH Cancer Center in Boston. The slides were
analyzed using cu ing edge technology, and her tumor was found to have a mutation
called EML4-ALK, which occurs in only 5% of lung cancers. The doctors at MGH
knew of a new drug called crizotinib that was being evaluated to treat lung cancers
with this specific mutation. Finding a specific mutation in a tumor and targeting that
mutation with particular drug is a cu ing edge approach to cancer treatment.
Sarah was given the new drug—and her tumors shrunk! She was in remission for
over 2 years. In 2010, the tumors returned, and Sarah traveled back to Boston for
further drug treatment, which was not successful. She developed brain metastases.
Her doctors in Boston knew of one more targeted therapy drug called ceritinib that
was still in clinical trials and therefore would not be available for patients. However,
through coordinated and persistent efforts, the pharmaceutical company (Novartis)
allowed her advance, compassionate access to the drug, and it worked for 2 years!
Because it was seen that this drug was effective against lung cancer in patients with
relapsed disease, the FDA has now given the drug rapid approval.
In April 2013, Sarah lost her ba le with lung cancer. But her case serves as an
example of the importance of exploring all options and remaining open to new cancer
treatments, such as targeted therapy.
813
Case Report
A 22-year-old man who was a known heroin abuser was admi ed to an emergency
department comatose, with shallow respirations. Routine laboratory studies and chest
x-ray studies were done after the patient was aroused. He was then transferred to the
ICU. He complained of left-sided chest pain. Examination of the chest film showed
three fractured ribs on the right and a large right pleural effusion. Further questioning
of a friend revealed that he had fallen and struck the corner of a table after injecting
heroin.
The diagnosis was traumatic hemothorax secondary to rib fractures, and a chest
tube was inserted into the right pleural space. No blood could be obtained despite
maneuvering of the tube. Another chest x-ray showed that the tube was correctly
placed in the right pleural space, but the fractured ribs and pleural effusion were on
the left. The radiologist then realized that he had reversed the first film. A second tube
was inserted into the left pleural space, and 1500 mL [6 to 7 cups] of blood was
evacuated.
X-Ray and Bronchoscopy Reports
1. CXR: Complete opacification of left hemithorax with deviation of mediastinal
structures of right side. Massive pleural effusion.
2. Chest tomograms: Mass most compatible with LUL bronchogenic carcinoma.
Possible left paratracheal adenopathy or direct involvement of mediastinum.
3. Bronchoscopy: Larynx, trachea, carina [area of bifurcation or forking of the
trachea], and left lung all within normal limits. On the right side there was
irregularity and roughening of the bronchial mucosa on the lateral aspect of the
bronchial wall. This irregularity extended into the RUL, and the apical and
posterior segments [divisions of lobes of the lung] each contained inflamed
irregular mucosa. Conclusion: Suspicious for infiltrating tumor, but may be
nonspecific inflammation. Bronchial washings, brushings, and bxs [biopsies]
taken. Bronchial biopsy diagnosis: squamous cell carcinoma. Washings and
brushings showed no malignant cells.
In Person
Recurrent Pneumonia
814
While growing up in West Virginia in the 1940s and 50s, I was frighteningly aware of
the prevalence of lung diseases. With coal mining at its peak, large numbers of miners
suffered and died from black lung disease. Tuberculosis was not uncommon, and
neither was pneumonia. Li le did I imagine, then or in 1999, when I first contracted
the disease, that recurring pneumonia would become my most troublesome medical
issue.
As bi er cold temperatures persisted during the winter of 1999, I was not
particularly concerned about a lingering cold and cough. But when I developed a lowgrade fever and decreased energy, a chest x-ray confirmed that I had pneumonia in
my left lung (lower lobe). My doctor prescribed a one-week course of antibiotics and
reassured me that the diagnosis was not unusual. I quickly improved and a follow-up
x-ray showed that the pneumonia had cleared. My doctor then suggested that I
receive the pneumonia vaccine, which produces antibodies against many types of
pneumococcal bacteria. End of story. Or so I thought.
In October of 2001, at age 60, I began training to run the Boston Marathon. A few
days after a long training run in January of 2002, I could not stop coughing. Once
again, a low-grade fever and rather marked fatigue set in. The thought of pneumonia
did not cross my mind initially. But, when symptoms didn't improve, a visit to my
doctor and a chest x-ray confirmed my second diagnosis of pneumonia, again in my
left lower lobe. I felt some relief when my physician, a pulmonologist and a serious
runner himself, assured me that cold weather training had not caused the pneumonia.
After a course of antibiotics, a follow-up chest CT performed in May showed no
abnormal result, and bronchoscopy ruled out any malignancy. Relieved, I assumed I
was finished with pneumonia.
However, pneumonia wasn't finished with me. I had periods where I went almost 6
years without a recurrence, but over and over, despite pulmonary function tests that
were normal and trials of steroids, I seem to always end up with pneumonia when I
develop even the slightest “cold.”
With all the information, gathered and evaluated by experts, what happens next? At
this point, the doctors conclude that my pneumonia is probably idiopathic. They
suggest that I have a follow-up CT scan and additional testing when pneumonia
episodes actually occur. They also caution me about exposure around children and
hospitalized patients. I asked my lung specialist if he thought this pneumonia puzzle
would ever be resolved. His reply was, “Something is going on that we will eventually
understand. We just haven’t figured it out yet.” Unse ling and stress producing as
this has been, I know I am fortunate to be dealing with an illness that has, so far,
responded to medication. Still, every time I get cold signs and symptoms, I worry.
And I never take good health for granted.
Brenda Melson's professional career was in teaching, counseling, and college advising.
815
Exercises
Remember to check your answers carefully with the Answers to Exercises, page 466.
A Match the listed anatomic structures with the descriptions that
follow.
adenoids
alveoli
bronchi
bronchioles
cilia
epiglo is
hilum
larynx
mediastinum
palatine tonsils
paranasal sinuses
parietal pleura
pharynx
trachea
visceral pleura
1. outer fold of pleura lying closer to the ribs
_______________________.
2. collections of lymph tissue in the nasopharynx
_______________________.
3. windpipe _______________________.
4. lid-like piece of cartilage that covers the voice box
_______________________.
5. branches of the windpipe that lead into the lungs
_______________________.
6. region between the lungs in the chest cavity
_______________________.
7. air-containing cavities in the bones around the nose
_______________________.
8. thin hairs a ached to the mucous membrane lining the
respiratory tract _______________________.
816
9. inner fold of pleura closer to lung tissue
_______________________.
10. throat _______________________.
11. air sacs of the lung _______________________.
12. voice box _______________________.
13. smallest branches of bronchi _______________________.
14. collections of lymph tissue in the oropharynx
_______________________.
15. midline region of the lungs where bronchi, blood vessels, and
nerves enter and exit the lungs _______________________.
B Complete the following sentences.
1. The apical part of the lung is the _______________________.
2. The gas that passes into the bloodstream at the lungs is
__________________________.
3. Breathing in air is called __________________________.
4. Divisions of the lungs are known as
__________________________.
5. The gas produced by cells and exhaled through the lungs is
______________________________.
6. The space between the visceral and the parietal pleura is the
______________________________.
7. Breathing out air is called ___________________________.
8. The term that describes the essential parts of the lung
(bronchiole and alveoli), responsible for respiration is
pulmonary ____________________.
9. The exchange of gases in the lung is
________________________ respiration.
10. The exchange of gases at the tissue cells is
________________________ respiration.
C Give meanings for the following terms relating to respiratory
disorders and structures.
1. bronchiectasis
_______________________________________________________
______________
817
2. pleuritis
_______________________________________________________
______________
3. pneumothorax
_______________________________________________________
______________
4. anosmia
_______________________________________________________
______________
5. laryngectomy
_______________________________________________________
______________
6. nasopharyngitis
_______________________________________________________
______________
7. phrenic
_______________________________________________________
______________
8. alveolar
_______________________________________________________
______________
9. glo is
_______________________________________________________
______________
10. tracheal stenosis
_______________________________________________________
______________
D Complete the medical terms for the following respiratory
symptoms.
1. excessive carbon dioxide in the blood: hyper
________________________
2. breathing is easiest or possible only in an upright position:
________________________ pnea
3. difficult breathing: ________________________ pnea
4. condition of blueness of skin: ________________________ osis
5. spi ing up blood: hemo ________________________
818
6. deficiency of oxygen: hyp ________________________
7. condition of pus in the pleural cavity: pyo __________________
or em __________________
8. hoarseness; voice impairment: dys ________________________
9. blood in the pleural cavity: hemo ________________________
10. nosebleed: epi ________________________
E Give the meanings of the following medical terms.
1. rales (crackles)
_____________________________________________
2. auscultation
_____________________________________________
3. sputum _____________________________________________
4. percussion _____________________________________________
5. rhonchi _____________________________________________
6. pleural rub _____________________________________________
7. purulent _____________________________________________
8. paroxysmal nocturnal dyspnea
_____________________________________________
9. expectoration
_____________________________________________
10. pulmonary infarction
_____________________________________________
11. stridor _____________________________________________
12. wheeze _____________________________________________
F Match the lung pathology terms with the descriptions that
follow.
asbestosis
asthma
atelectasis
chronic bronchitis
croup
cystic fibrosis
diphtheria
emphysema
819
infiltrate
lung cancer
pertussis
sarcoidosis
1. Acute infectious disease of the throat caused by
Corynebacterium: ________________________
2. Acute respiratory syndrome in children and infants that is
marked by obstruction of the larynx and stridor:
________________________
3. Hyperinflation of air sacs with destruction of alveolar walls:
________________________
4. Long-term inflammation of the lining of bronchial tubes;
cigare e smoking is a common cause:
________________________
5. Inflammatory disorder of bronchi and bronchioles; allergy is a
common cause: ______________________
6. Lung or a portion of a lung is collapsed:
________________________
7. Malignant neoplasm originating in a lung or bronchus:
________________________
8. Whooping cough: ________________________
9. A collection of fluid or other material within the lung as seen
on chest film, CT scan, or other radiologic study:
________________________
10. Inherited disease of exocrine glands; mucous secretions lead
to airway obstruction: ________________________
11. Type of pneumoconiosis; dust particles are inhaled:
________________________
12. Inflammatory disease in which small nodules form in lungs
and lymph nodes: ______________
G Use the listed terms and abbreviations to complete the
sentences that follow.
CPAP
DLCO
exudate
820
FEV1
fibrosis
obstructive lung disease
OSA
PaCO2
PaO2
palliative
restrictive lung disease
rhonchi
1. Sarah had a pulmonary function test in which she inhaled as
much air as she could and the air that she expelled in the first
second was measured. The result of this PFT is a/an
________________________.
2. Dr. Smith heard loud ________________________ when he
auscultated Kate's chest. Her bronchial tubes were obstructed
with thick mucous secretions.
3. Karl was asked to breathe in a small amount of carbon
monoxide and then blood samples were taken to detect the gas
in his bloodstream. This PFT assesses how well gases can
diffuse across the alveolar membrane, and the result of the test
is called ________________________.
4. Formation of scar tissue in the connective tissue of the lungs is
pulmonary ________________________.
5. A purulent ________________________ consists of white blood
cells, microorganisms (dead and alive), and other debris.
6. Myasthenia gravis and muscular dystrophy are examples of
neuromuscular conditions that produce
________________________.
7. Chronic bronchitis and asthma are examples of
________________________.
8. Patients with a small pharyngeal airway that closes during
sleep may experience ________________________.
9. With nasal ________________________, positive pressure (air
coming from a compressor) opens the oropharynx and
nasopharynx, preventing obstructive sleep apnea.
821
10. Doctors realized that they could not cure Jean's
adenocarcinoma of the lung. They used
________________________ measures to relieve her
uncomfortable symptoms.
11. During an apneic period, a patient experiences severe
hypoxemia (decreased ________________________) and
hypercapnia (increased ________________________).
H Give the meanings of the following medical terms.
1. pulmonary abscess
_______________________________________________________
__________
2. pulmonary edema
_______________________________________________________
__________
3. pneumoconiosis
_______________________________________________________
__________
4. pneumonia
_______________________________________________________
__________
5. pulmonary embolism
_______________________________________________________
__________
6. tuberculosis
_______________________________________________________
__________
7. pleural effusion
_______________________________________________________
__________
8. pleurisy
_______________________________________________________
__________
9. anthracosis
_______________________________________________________
__________
10. mesothelioma
_______________________________________________________
822
__________
11. adenoid hypertrophy
_______________________________________________________
__________
12. pleurodynia
_______________________________________________________
__________
13. expectoration
_______________________________________________________
__________
14. tachypnea
_______________________________________________________
__________
I Match the clinical procedure or abbreviation with its
description.
bronchoalveolar lavage
bronchoscopy
CT pulmonary angiography
endotracheal intubation
laryngoscopy
mediastinoscopy
pulmonary function tests
thoracentesis
tracheostomy
tube thoracostomy
tuberculin tests
V/Q scan
1. Placement of a tube through the mouth into the trachea to
establish an airway: ________________________
2. Injection or inhalation of radioactive material and recording
images of its distribution in the lungs:
________________________
3. Tine and Mantoux tests: ________________________
4. Puncture of the chest wall to obtain fluid from the pleural
cavity: ________________________
823
5. Tests that measure the ventilation mechanics of the lung:
________________________
6. Creation of an opening into the trachea through the neck to
establish an airway: ________________________
7. Visual examination of the bronchi: ________________________
8. Injection of fluid into the bronchi, followed by withdrawal of
the fluid for examination: ________________________
9. Insertion of an endoscope into the larynx to view the voice
box: ________________________
10. Combination of computer-generated x-ray images and
recording (with contrast) of blood flow in the lung:
________________________
11. Visual examination of the area between the lungs:
________________________
12. Continuous drainage of the pleural spaces from a chest tube
placed through a small skin incision:
________________________
J Spell out the following abbreviations and then select the le er
of the description that is the best definition for each.
824
COLUMN I
1. DOE
______________________________________________________________________________
2. PND
_______________________________________________________________________________
3. VATS
_____________________________________________________________________________
4. CPR
________________________________________________________________________________
5. NSCLC _______________________________________________________________________
6. ARDS
____________________________________________________________________________
7. COPD
___________________________________________________________________________
8. PFTs
______________________________________________________________________________
9. PPD
________________________________________________________________________________
10. DPT
________________________________________________________________________________
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
COLUMN II
A. Patients with
congestive heart
failure and
pulmonary
edema
experience this
symptom when
they recline in
bed.
B. Chronic
bronchitis and
emphysema are
examples.
C. Substance used
in the test for
tuberculosis.
D.
Adenocarcinoma
and squamous
cell carcinoma
are types.
E. Visual
examination of
the chest via
endoscope and a
video monitor.
F. Injection in an
infant to provide
immunity.
G. A spirometer is
used for these
respiratory tests.
H. This symptom
means that a
patient has
difficulty
breathing and
becomes short of
breath when
exercising.
I. Three basic steps:
A, airway
opened by tilting
the head; B,
breathing
restored by
mouth-to-mouth
breathing; C,
circulation
restored by
external cardiac
compressions.
J. A group of
symptoms
resulting in
acute respiratory
failure.
K Match the respiratory system procedures with their meanings.
laryngectomy
lobectomy
pneumonectomy
rhinoplasty
thoracentesis
thoracoscopy (thorascopy)
825
thoracotomy
tonsillectomy
1. removal of lymph tissue in the oropharynx
________________________
2. surgical puncture of the chest to remove fluid from the pleural
space ________________________
3. surgical repair of the nose ________________________
4. incision of the chest ________________________
5. removal of the voice box ________________________
6. removal of a region of a lung ________________________
7. endoscopic examination of the chest
________________________
8. pulmonary resection ________________________
L Circle the boldface terms that best complete the meaning of
each sentence.
1. Ruth was having difficulty taking a deep breath, and her chest
x-ray showed accumulation of fluid in her pleural spaces. Dr.
Smith ordered (PPD, tracheotomy, thoracentesis) to relieve
the pressure on her lungs.
2. Dr. Wong used her stethoscope to perform (percussion,
auscultation, thoracentesis) on the patient's chest.
3. Before making a decision to perform surgery on Mrs. Hope, an
80-year-old woman with lung cancer, her physicians ordered
(COPD, bronchoscopy, PFTs) to determine the functioning of
her lungs.
4. Sylvia produced yellow-colored sputum and had a high fever.
Her physician told her that she probably had (pneumonia,
pulmonary embolism, pneumothorax) and needed
antibiotics.
5. The night before her thoracotomy for lung biopsy, Mrs. White
was told by her anesthesiologist that he would place a/an
(thoracostomy tube, mediastinoscope, endotracheal tube)
down her throat to keep her airway open during surgery.
6. Early in her pregnancy, Sonya had a routine (PET scan, CXR,
MRI) that revealed a/an (epiglo ic, alveolar, mediastinal)
mass in the area between her lungs. After delivery of her child,
826
the mass was removed, and biopsy revealed a malignant
thymoma (tumor of the thymus gland).
7. Five-year-old Seth was allergic to cats and experienced
wheezing, coughing, and difficult breathing at night when he
was trying to sleep. After careful evaluation by a (cardiologist,
pulmonologist, neurologist), his parents were told that Seth
had (pleurisy, sarcoidosis, asthma) involving inflammation of
his (nasal passages, pharynx, bronchial tubes).
8. Six-year-old Daisy had a habit of picking her nose. During the
winter months, heat in her family's house caused drying of her
nasal (mucus, mucous, pleural) membranes. She had frequent
bouts of (epistaxis, croup, stridor).
9. Seventy-five-year-old Beatrice had been a pack-a-day smoker
all of her adult life. Over the previous 3 months she noticed a
persistent cough, weight loss, blood in her sputum
(hemoptysis, hematemesis, asbestosis), and dyspnea. A chest
CT scan revealed a mass. Biopsy confirmed the diagnosis of
(tuberculosis, pneumoconiosis, adenocarcinoma), which is a
type of (small cell, non–small cell, lymph node) lung cancer.
10. Carrie's lungs were normal at birth, but thick bronchial
secretions soon blocked her (arterioles, venules, bronchioles),
which became inflamed. She was losing weight, and tests
revealed inadequate amounts of pancreatic enzymes necessary
for digestion of fats and proteins. Her pediatrician diagnosed
her hereditary condition as (chronic bronchitis, asthma, cystic
fibrosis).
827
Answers to Exercises
A
1. parietal pleura
2. adenoids
3. trachea
4. epiglo is
5. bronchi
6. mediastinum
7. paranasal sinuses
8. cilia
9. visceral pleura
10. pharynx
11. alveoli
12. larynx
13. bronchioles
14. palatine tonsils
15. hilum
B
1. uppermost part
2. oxygen
3. inspiration; inhalation
4. lobes
5. carbon dioxide
6. pleural cavity
7. expiration; exhalation
8. parenchyma
9. external
828
10. internal
C
1. chronic dilation of a bronchus
2. inflammation of pleura
3. air in the chest (pleural cavity)
4. lack of sense of smell
5. removal of the voice box
6. inflammation of the nose and throat
7. pertaining to the diaphragm
8. pertaining to an air sac
9. opening to the larynx
10. narrowing of the windpipe
D
1. hypercapnia
2. orthopnea
3. dyspnea
4. cyanosis
5. hemoptysis
6. hypoxia
7. pyothorax; empyema
8. dysphonia
9. hemothorax
10. epistaxis
E
1. fine crackling sounds heard during inhalation when there is fluid
in the alveoli
2. listening to sounds within the body
829
3. material expelled from the respiratory tract by deep coughing
and spi ing
4. tapping on the surface to determine the underlying structure
5. loud rumbling sounds on auscultation of chest; bronchi
obstructed by sputum
6. scratching sound produced by pleural surfaces rubbing against
each other (caused by inflammation or tumor cells)
7. pus-filled
8. sudden a ack of difficult breathing associated with lying down
at night (caused by congestive heart failure and pulmonary
edema as the lungs fill with fluid)
9. clearing of secretions from the throat or lungs by coughing
10. area of dead tissue in the lung
11. strained, high-pitched inspirational sound
12. continuous high-pitched whistling sound produced during
breathing when air is forced through a narrow space; heard in
asthma
F
1. diphtheria
2. croup
3. emphysema
4. chronic bronchitis
5. asthma
6. atelectasis
7. lung cancer
8. pertussis
9. infiltrate
10. cystic fibrosis
11. asbestosis
12. sarcoidosis
830
G
1. PEV1 (forced expiratory volume in first second)
2. rhonchi
3. DLCO (diffusion capacity of the lung for carbon monoxide)
4. fibrosis
5. exudate
6. restrictive lung disease
7. obstructive lung disease
8. OSA: obstructive sleep apnea
9. CPAP: continuous positive airway pressure
10. palliative
11. PaO2, PaCO2
H
1. collection of pus in the lungs
2. swelling, fluid collection in the air sacs and bronchioles
3. abnormal condition of dust in the lungs
4. acute inflammation and infection of alveoli; they become filled
with fluid and blood cells
5. floating clot or other material blocking the blood vessels of the
lung
6. an infectious disease caused by rod-shaped bacilli and producing
tubercles (nodes) of infection
7. collection of fluid in the pleural cavity
8. inflammation of pleura
9. abnormal condition of coal dust in the lungs (black lung disease)
10. malignant tumor arising in the pleura; composed of
mesothelium (epithelium that covers the surfaces of membranes
such as pleura and peritoneum)
831
11. excessive growth of cells in the adenoids (lymph tissue in the
nasopharynx)
12. pain of the pleura (irritation of pleural surfaces leads to
intercostal pain)
13. coughing up of material from the chest
14. rapid breathing; hyperventilation
I
1. endotracheal intubation
2. V/Q scan
3. tuberculin tests
4. thoracentesis
5. pulmonary function tests
6. tracheostomy
7. bronchoscopy
8. bronchoalveolar lavage
9. laryngoscopy
10. CT pulmonary angiography
11. mediastinoscopy
12. tube thoracostomy
J
1. dyspnea on exertion: H
2. paroxysmal nocturnal dyspnea: A
3. video-assisted thoracic surgery: E
4. cardiopulmonary resuscitation: I
5. non–small cell lung cancer: D
6. acute (adult) respiratory distress syndrome: J
7. chronic obstructive pulmonary disease: B
8. pulmonary function tests: G
832
9. purified protein derivative: C
10. diphtheria, pertussis, and tetanus: F
K
1. tonsillectomy
2. thoracentesis
3. rhinoplasty
4. thoracotomy
5. laryngectomy
6. lobectomy
7. thoracoscopy (thorascopy)
8. pneumonectomy
L
1. thoracentesis
2. auscultation
3. PFTs
4. pneumonia
5. endotracheal tube
6. CXR; mediastinal
7. pulmonologist; asthma; bronchial tubes
8. mucous; epistaxis
9. hemoptysis; adenocarcinoma; non–small cell
10. bronchioles; cystic fibrosis
Pronunciation of Terms
The terms you have learned in this chapter are presented here with their
pronunciations. The meanings for all the terms are in the Mini-Dictionary beginning
on page 897. You can also hear each term pronounced on the Evolve website
(h p://evolve.elsevier.com/Chabner/language/).
Vocabulary and Terminology
833
TERM
adenoid hypertrophy
adenoidectomy
adenoids
alveolar
alveolus; alveoli
anosmia
apex of the lung
apical
apnea
asphyxia
atelectasis
base of the lung
bronchiectasis
bronchioles
bronchiolitis
bronchodilator
bronchopleural
bronchospasm
bronchus; bronchi
carbon dioxide
cilia
cyanosis
diaphragm
dysphonia
dyspnea
empyema
epiglo is
epiglo itis
exhalation
expectoration
expiration
glo is
hemoptysis
hemothorax
hilar
hilum of the lung
hypercapnia
hyperpnea
hypoxia
inhalation
inspiration
laryngeal
laryngitis
laryngospasm
larynx
lobectomy
mediastinoscopy
mediastinum
nares
nasogastric intubation
orthopnea
oxygen
palatine tonsil
paranasal sinus
parietal pleura
pharyngeal
pharynx
phrenic nerve
pleura
pleural cavity
pleurodynia
pneumonectomy
PRONUNCIATION
ah-deh-noyd hi-PER-tro-fe
ah-deh-noyd-EK-to-me
AH-deh-noydz
al-ve-O-lar
al-VE-o-lus; al-VE-o-li
an-OZ-me-ah
A-pex of the lung
A-pih-kal
AP-ne-ah
as-FIX-se-ah
at-eh-LEK-tah-sis
base of the lung
brong-ke-EK-tah-sis
BRONG-ke-ohlz
brong-ke-o-LI-tis
brong-ko-DI-la-tor
brong-ko-PLU-ral
BRONG-ko-spaz-im
BRONG-kus; BRONG-ki
KAR-bon di-OX-ide
SIL-e-ah
si-ah-NO-sis
DI-ah-fram
dis-FO-ne-ah
DISP-ne-ah
em-pi-E-mah
ep-ih-GLOT-is
ep-ih-glot-TI-is
ex-hal-A-shun
ex-spek-tor-RA-shun
ex-pih-RA-shun
GLOT-is
he-MOP-tih-sis
he-mo-THO-rax
HI-lar
HI-lum of the lung
hi-per-KAP-ne-ah
hi-PERP-ne-ah
hi-POX-e-ah
in-hah-LA-shun
in-spih-RA-shun
lah-rin-JE-al
lah-rin-JI-tis
lah-RING-go-spaz-im
LAR-inks
lo-BEK-to-me
me-de-ah-sti-NOS-ko-pe
me-de-ah-STI-num
NA-reez
na-zo-GAS-trik in-tu-BA-shun
or-THOP-ne-ah
OX-ih-jen
PAH-lih-tine TON-sil
par-ah-NA-zal SI-nus
pah-RI-eh-tal PLU-rah
fah-rin-JE-al
FAH-rinks
FREN-ik nerv
PLUR-ah
PLUR-al KAV-ih-te
plur-o-DIN-e-ah
nu-mo-NEK-to-me
834
TERM
pneumothorax
pulmonary
pulmonary parenchyma
pyothorax
respiration
rhinoplasty
rhinorrhea
sinusitis
spirometer
tachypnea
thoracic
thoracotomy
tonsillectomy
trachea
tracheal stenosis
visceral pleura
PRONUNCIATION
nu-mo-THO-rax
PUL-mo-nair-e
pul-mo-NAIR-e pah-RENK-ih-mah
pi-o-THO-rax
res-pih-RA-shun
RI-no-plas-te
ri-no-RE-ah
si-nu-SI-tis
spi-ROM-eh-ter
tah-KIP-ne-ah
thor-AH-sik
thor-ah-KOT-o-me
ton-sih-LEK-to-me
TRA-ke-ah
TRA-ke-al steh-NO-sis
VIS-er-al PLUR-ah
Pathologic Conditions, Laboratory Tests, and Clinical Procedures
835
TERM
anthracosis
asbestosis
asthma
atelectasis
auscultation
bacilli
bronchoalveolar lavage
bronchoscopy
chronic bronchitis
chronic obstructive pulmonary disease
computed tomography of the chest
cor pulmonale
croup
cystic fibrosis
diphtheria
emphysema
endotracheal intubation
epistaxis
exudate
infiltrate
laryngoscopy
lung biopsy
lung cancer
magnetic resonance imaging of the chest
mesothelioma
obstructive lung disease
palliative
paroxysmal
percussion
pertussis
pleural effusion
pleural rub
pleurisy
pneumoconiosis
pneumonia
positron emission tomography of the lung
pulmonary abscess
pulmonary edema
pulmonary embolism
pulmonary fibrosis
pulmonary function tests
pulmonary infarction
purulent
rales
restrictive lung disease
rhonchi
sarcoidosis
silicosis
sputum
sputum culture
stridor
thoracentesis
thoracoscopy
thoracotomy
tracheostomy
tracheotomy
tube thoracostomy
tuberculin test
tuberculosis
ventilation-perfusion scan
wheezes
PRONUNCIATION
an-thrah-KO-sis
as-bes-TO-sis
AZ-mah
at-eh-LEK-tah-sis
aw-skul-TA-shun
bah-SIL-i
BRONG-ko-al-ve-O-lar lah-VAJ
brong-KOS-ko-pe
KRON-ik brong-KI-tis
KRON-ik ob-STRUK-tiv PUL-mo-NAIR-e dih-ZEEZ
kom-PU-tid to-MOG-rah-fe of the chest
kor pul-mo-NAH-le
kroop
SIS-tik fi-BRO-sis
dif-THE-re-ah
em-fi-ZE-mah
en-do-TRA-ke-al in-tu-BA-shun
ep-ih-STAX-is
EX-su-dayt
IN-fil-trayt
lah-rin-GOS-ko-pe
lung BI-op-se
lung KAN-ser
mag-NET-ik REH-zo-nants IM-aj-ing of the chest
mez-o-the-le-O-mah
ob-STRUK-tiv lung dih-ZEEZ
PAH-le-ah-tiv
par-ox-IZ-mal
per-KUH-shun
per-TUH-sis
PLUR-al eh-FU-zhun
PLUR-al rub
PLUR-ih-se
nu-mo-ko-ne-O-sis
nu-MO-nyah
POS-ih-tron e-MIH-shun to-MOG-rah-fe of the lung
PUL-mo-nair-e AB-ses
PUL-mo-nair-e eh-DE-mah
PUL-mo-nair-e EM-bo-liz-m
PUL-mo-nair-e fi-BRO-sis
PUL-mo-nair-e FUNK-shun tests
PUL-mo-nair-e in-FARK-shun
PU-ru-lent
raylz
re-STRIK-tiv lung dih-ZEEZ
RONG-ki
sar-koy-DO-sis
sil-ih-KO-sis
SPU-tum
SPU-tum KUL-chur
STRI-dor
thor-ah-sen-TE-sis
thor-ah-KOS-ko-pe
thor-ah-KOT-o-me
tra-ke-OS-to-me
tra-ke-OT-o-me
toob thor-ah-KOS-to-me
tu-BER-ku-lin test
tu-ber-ku-LO-sis
ven-tih-LA-shun - per-FU-zhun scan
WEEZ-ez
836
Review Sheet
Write the meanings of the word parts in the spaces provided. Check your answers
with the information in the chapter or in the Glossary (Medical Word Parts—English)
at the end of the book.
Combining Forms
COMBINING FORM
adenoid/o
alveol/o
bronch/o
bronchi/o
bronchiol/o
capn/o
coni/o
cyan/o
epiglo /o
laryng/o
lob/o
mediastin/o
nas/o
or/o
orth/o
ox/o
pector/o
pharyng/o
phon/o
phren/o
pleur/o
pneum/o
pneumon/o
pulmon/o
py/o
rhin/o
sinus/o
spir/o
tel/o
thorac/o
tonsill/o
trache/o
MEANING
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
Suffixes
837
SUFFIX
-algia
-capnia
-centesis
-dynia
-ectasis
-ectomy
-ema
-lysis
-osmia
-oxia
-phonia
-plasty
-pnea
-ptysis
-rrhea
-scopy
-sphyxia
-stenosis
-stomy
-thorax
-tomy
-trophy
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Prefixes
PREFIX
a-, anbradydysemeuexhyperhypoparaperretachy-
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Label the following lung abnormalities: atelectasis, pleural effusion,
pneumothorax, and pulmonary edema.
838
839
CHAPTER 13
840
Blood System
CHAPTER SECTIONS:
Introduction 474
Composition and Formation of Blood 474
Blood Types 480
Blood Clotting 480
Vocabulary 482
Terminology 484
Pathology 487
Laboratory Tests and Clinical Procedures 492
Abbreviations 496
Practical Applications 497
In Person: Autologous Stem Cell Transplant 499
Exercises 500
Answers to Exercises 506
Pronunciation of Terms 508
Review Sheet 511
CHAPTER GOALS
• Identify terms relating to the composition, formation, and function of blood.
• Differentiate among the four major blood types.
• Identify terms related to blood clotting.
• Build words and recognize combining forms used in blood system terminology.
• Identify various pathologic conditions affecting blood.
• Describe various laboratory tests and clinical procedures used with hematologic disorders, and
recognize relevant abbreviations.
• Apply your new knowledge to understanding medical terms in their proper contexts, such as
medical reports and records.
841
842
Introduction
The primary function of blood is to maintain a constant environment for the other living
tissues of the body. Blood transports nutrients, gases, and wastes to and from the cells of
the body. Nutrients from food, digested in the stomach and small intestine, pass into the
bloodstream through the lining cells of the small intestine. Blood then carries these
nutrients to all body cells. Oxygen enters the body through the air sacs of the lungs. Red
blood cells then transport the oxygen to cells throughout the body. Blood also helps remove
the waste products released by cells. It carries gaseous waste (such as carbon dioxide) to the
lungs to be exhaled. It carries chemical waste, such as urea, to the kidneys to be excreted in
the urine.
Blood transports chemical messengers called hormones from their sites of secretion in
glands, such as the thyroid or pituitary, to distant sites where they regulate growth,
reproduction, and energy production. These hormones are discussed later in the endocrine
chapter, page 699.
Finally, blood contains proteins, white blood cells and antibodies that fight infection, and
platelets (thrombocytes) and other proteins that help the blood to clot.
843
Composition and Formation of Blood
Blood is composed of cells (45% of blood volume), or formed elements, suspended in a
clear, straw-colored liquid called plasma (55% of blood volume). The cells are erythrocytes
(red blood cells or RBCs), leukocytes (white blood cells or WBCs), and platelets or
thrombocytes (clo ing cells). Plasma is a solution of water, proteins, sugar, salts,
hormones, lipids, and vitamins.
A Drop of Blood
A small drop of blood normally contains approximately 4-6 million RBCs, 7-10 thousand
WBC, 150-450 thousand platelets.
Cells
Beginning at birth, all blood cells originate in the marrow cavity of bones. Both the red
blood cells that carry oxygen and the white blood cells that fight infection arise from the
same blood-forming or hematopoietic stem cells. Under the influence of proteins in the
blood and bone marrow, stem cells change their size and shape to become specialized, or
differentiated. In this process, the cells change in size from large (immature cells) to small
(mature forms), and the cell nucleus shrinks (in red cells, the nucleus actually disappears).
Figure 13-1 illustrates these changes in the formation of blood cells. Use Figure 13-1 as a
reference as you learn the names of mature blood cells and their earlier forms.
844
FIGURE 13-1 Stages in blood cell development (hematopoiesis). All blood cells
originate from hematopoietic stem cells. Progenitor cells are derived from
hematopoietic stem cells. Myeloid progenitor cells give rise to erythroblasts,
megakaryoblasts, myeloblasts and monoblasts. Lymphoid progenitor cells give
rise to lymphoblasts. Notice that the suffix -blast indicates immature forms of all cells.
Band cells are identical to segmented granulocytes except that the nucleus is Ushaped and it does not have distinct nuclear lobes.
Erythrocytes
As a red blood cell matures (from erythroblast to erythrocyte), it loses its nucleus and
assumes the shape of a biconcave disk. This shape (a depressed or hollow surface on each
side of the cell, resembling a cough drop with a thin central portion) allows for a large
surface area so that absorption and release of gases (oxygen and carbon dioxide) can take
place (Figure 13-2A and B). Red cells contain the unique protein hemoglobin, composed of
heme (iron-containing pigment) and globin (protein). Hemoglobin enables the erythrocyte
to carry oxygen. The combination of oxygen and hemoglobin (oxyhemoglobin) produces
the bright red color of blood.
845
FIGURE 13-2 A, Normal erythrocytes (red blood cells). B, Electron micrograph
showing erythrocytes within a capillary. Note the classic biconcave or “dumbbell”
shape (DB) seen when the erythrocyte is cut through its thin central zone. A platelet (P)
is seen as well.
Erythrocytes originate in the bone marrow. The hormone called erythropoietin (secreted
by the kidneys) stimulates their production (-poiesis means formation). Erythrocytes live
and fulfill their role of transporting gases for about 120 days in the bloodstream. After this
time, macrophages (in the spleen, liver, and bone marrow) destroy the worn-out
erythrocytes. From 2 million to 10 million red cells are destroyed each second, but because
they are constantly replaced, the number of circulating cells remains constant at 4 million to
6 million per microliter (µL) of blood.
Macrophages break down erythrocytes and hemoglobin into heme and globin (protein)
portions. The heme releases iron and decomposes into a yellow-orange pigment called
bilirubin. The iron in hemoglobin is used again to form new red cells or is stored in the
spleen, liver, or bone marrow. Bilirubin is excreted into bile by the liver, and from bile it
enters the small intestine via the common bile duct. Finally it is excreted in the stool, where
its color changes to brown. Figure 13-3 reviews the sequence of events in hemoglobin
breakdown.
FIGURE 13-3 The breakdown of hemoglobin.
Leukocytes
White blood cells (7000 to 10,000 cells per microliter of blood) are less numerous than
erythrocytes, but there are five different types of mature leukocytes, shown in Figure 13-4.
These are three polymorphonuclear granulocytes: eosinophil, basophil, and neutrophil; and
two mononuclear leukocytes: lymphocyte and monocyte.
846
FIGURE 13-4 Leukocytes.
The granulocytes, or polymorphonuclear leukocytes (PMNs), are the most numerous
(about 60%). The three granulocytic leukocytes end with the suffix -phil (meaning a raction
to). This reflects their affinity for various dyes. Eosinophils contain granules that stain with
eosin, a red acidic dye. These cells increase in allergic responses and engulf substances that
trigger the allergies. Basophils contain granules that stain dark blue with a basic (alkaline)
dye. These granules contain heparin (an anticlo ing substance) and histamine (a chemical
released in allergic responses). Neutrophils contain granules that are neutral; they do not
stain intensely and show only a pale color. Neutrophils are phagocytes (phag/o means to
eat or swallow) that accumulate at sites of infection, where they ingest and destroy bacteria.
Figure 13-5 shows phagocytosis by a neutrophil.
FIGURE 13-5 Phagocytosis (ingestion) of a bacterium by a neutrophil.
Specific proteins called colony-stimulating factors (CSFs) promote the growth of
granulocytes in bone marrow. G-CSF (granulocyte CSF) and GM-CSF (granulocytemacrophage CSF) are given to cancer patients to restore granulocyte production.
Erythropoietin, like CSFs, can be produced by recombinant DNA techniques. It stimulates
red blood cell production (erythropoiesis). Normally erythropoietin is made by the kidney.
Thus patients with kidney failure can become anemic and are often treated with EPO to
stimulate red blood cell production.
Although all granulocytes are polymorphonuclear (they have multilobed nuclei), the
term polymorphonuclear granulocytes (“polys”) most often refers to neutrophils, which
are the most numerous of the granulocytes.
Mononuclear (containing one large nucleus) leukocytes do not have large numbers of
granules in their cytoplasm, but they may have a few granules. These are lymphocytes and
monocytes (see Figure 13-1). Lymphocytes are made in bone marrow and lymph nodes and
circulate both in the bloodstream and in the parallel circulating system, the lymphatic
system.
Lymphocytes play an important role in the immune response that protects the body
against infection. They can directly a ack foreign ma er and, in addition, make antibodies
that neutralize and can lead to the destruction of foreign antigens (bacteria and viruses).
847
Monocytes are phagocytic cells that also fight disease. As macrophages, they move from
the bloodstream into tissues and dispose of dead and dying cells and other tissue debris by
phagocytosis.
Table 13-1 reviews the different types of leukocytes, their numbers in the blood, and their
functions.
TABLE 13-1
LEUKOCYTES
LEUKOCYTE
NORMAL PERCENTAGE IN
BLOOD
Granulocytes
Basophil
0-1
Eosinophil
1-4
FUNCTION
Responds to allergens; releases histamine and heparin
Responds to parasitic infections and is a phagocyte in allergic
reactions
Major role in fighting bacterial infection; phagocyte
Neutrophil
50-70
Mononuclear Cells
Lymphocyte 20-40
Monocyte
3-8
Controls the immune response; makes antibodies to antigens
Phagocytic cell that becomes a macrophage and digests bacteria
and tissue debris
Platelets (Thrombocytes)
Platelets, actually blood cell fragments, are formed in bone marrow from giant cells with
multilobed nuclei called megakaryocytes (Figure 13-6A and B). The main function of
platelets is to help blood to clot. Specific terms related to blood clo ing are discussed later
in this chapter.
FIGURE 13-6 A, Megakaryocyte. B, Platelets.
Plasma
Plasma, the liquid part of the blood, consists of water, dissolved proteins, nutrients, wastes,
salts, hormones, lipids, and vitamins. The four major plasma proteins are albumin,
globulins, fibrinogen, and prothrombin (the last two are clo ing proteins).
Albumin maintains the proper proportion (and concentration) of water in the blood.
Because albumin cannot pass easily through capillary walls, it remains in the blood and
carries smaller molecules bound to its surface. It a racts water from the tissues back into
848
the bloodstream and thus opposes the water's tendency to leave the blood and leak out into
tissue spaces. Edema (swelling) results when too much fluid from blood “leaks” out into
tissues. This happens in a mild form when a person ingests too much salt (water is retained
in the blood and seeps out into tissues) and in a severe form when a person is burned in a
fire. In this situation, albumin escapes from capillaries as a result of the burn injury. Then
water cannot be held in the blood; it escapes through the skin, and blood volume drops.
Globulins are another component of blood and one of the plasma proteins. There are
alpha, beta, and gamma globulins. The gamma globulins are immunoglobulins, which are
antibodies that bind to and sometimes destroy antigens (foreign substances). Examples of
immunoglobulin antibodies are IgG (found in high concentration in plasma) and IgA
(found in breast milk, saliva, tears, and respiratory mucus). Other immunoglobulins are
IgM, IgD, and IgE. Immunoglobulins are separated from other plasma proteins by
electrophoresis. In this process, an electrical current passes through a solution of plasma.
The different proteins in plasma separate based mainly on their size and electric charge.
Plasmapheresis (-apheresis means removal) is the process of separating plasma from
cells. In plasmapheresis, the entire blood sample is spun in a centrifuge machine. Because
blood cells are larger and heavier, they move to the bo om of the sample, leaving the
plasma on top.
Figure 13-7 reviews the composition of blood.
FIGURE 13-7 The composition of blood.
849
Blood Types
Transfusions of whole blood (cells and plasma) are used to replace blood lost after injury,
during surgery, or in severe shock. A patient who is severely anemic and needs only red
blood cells will receive a transfusion of packed red cells (whole blood with most of the
plasma removed). Human blood falls into four main types: A, B, AB, and O. These types
are based on the antigens on red blood cells and the antibodies found in each person's
serum (Table 13-2).
TABLE 13-2
BLOOD TYPES
TYPE
A
B
AB
O
PERCENTAGE IN POPULATION
41
10
4
45
RED CELL ANTIGENS
A
B
A and B
No A and B
SERUM ANTIBODIES
Yes (anti-B)
Yes (anti-A)
No (anti-A or anti-B)
Yes (anti-A and anti-B)
There are harmful effects of transfusing blood from a donor of one blood type into a
recipient who has blood of another blood type. Therefore, before blood is transfused, both
the blood donor and the blood recipient are tested, to make sure that the transfused blood
will be compatible with the recipient's blood type. During transfusion, if blood is not
compatible, then hemolysis (breakdown of red blood cells) occurs. This may be followed
by excessive clo ing in blood vessels (disseminated intravascular coagulation, or DIC),
which is a life-threatening condition.
Besides A and B antigens, many other antigens are located on the surface of red blood
cells. One of these is called the Rh factor (named because it was first found in the blood of a
rhesus monkey). The term Rh positive (Rh+) refers to a person who is born with the Rh
antigen on his or her red blood cells. An Rh negative (Rh−) person does not have the Rh
antigen. See Chapter 4, page 114, for more information about the Rh factor. In clinical
practice, blood types are named to indicate both Rh and ABO antigen status. If a woman
has an A+ (A positive) blood type, for example, this means that she was born with both A
antigen and Rh antigen on her red blood cells. If a man has a B− (B negative) blood type,
this means he was born with the B antigen on his red blood cells but not Rh antigen.
Why is Type O the “Universal Donor” Blood Type?
Type O blood does not contain A or B red cell antigens and therefore will not react with
antibodies in any recipient's bloodstream. Anti-A and anti-B antibodies present in type O
blood become diluted in the recipient's bloodstream and do not cause an adverse reaction.
850
Blood Clotting
Blood clo ing, or coagulation, is a complicated process involving many different
substances and chemical reactions. The final result (usually taking less than 15 minutes) is
the formation of a fibrin clot from the plasma protein fibrinogen. The suffix -gen means
giving rise to. Platelets are important in beginning the process following injury to tissues or
blood vessels. The platelets become sticky and collect, or aggregate, at the site of injury.
Then, in combination with tissue and protein clo ing factors, plus calcium, vitamin K,
prothrombin, and thrombin, fibrinogen is converted to fibrin to form a clot (Figure 13-8).
One of the important clo ing factors is factor VIII. It is missing in some people who are
born with hemophilia. Other hemophiliacs are missing factor IX.
FIGURE 13-8 The sequence of events in blood clotting.
The fibrin threads form the clot by trapping red blood cells (Figure 13-9 shows a red
blood cell trapped by fibrin threads). Then the clot retracts into a tight ball, leaving behind
a clear fluid called serum. Serum is related to plasma. It is plasma after the clo ing factors
have been removed. Normally, clots (thrombi) do not form in blood vessels unless the
vessel is damaged or the flow of blood is impeded. Anticoagulant substances in the blood
inhibit blood clo ing, so clots do not form. Heparin, produced by tissue cells (especially in
the liver), is an example of an anticoagulant. Other drugs such as warfarin (Coumadin) are
given to patients with thromboembolic diseases to prevent the formation of clots. Direct
oral anticoagulants (DOACs) work by inhibiting blood clo ing factors such as thrombin.
851
FIGURE 13-9 A red blood cell enmeshed in threads of fibrin.
Vocabulary
This list reviews many of the new terms introduced in the text. Short definitions reinforce
your understanding of the terms. Refer to the Pronunciation of Terms on page 508 for help
with difficult or unfamiliar words.
852
albumin
antibody (Ab)
Major protein in blood; maintains the proper amount of water in the blood.
Specific protein (immunoglobulin) produced by lymphocytes in response to bacteria, viruses,
or other antigens. An antibody is specific to an antigen and inactivates it.
antigen
Foreign substance or toxin that stimulates the production of an antibody.
basophil
White blood cell containing granules that stain blue (with basic dye) associated with release of
histamine and heparin.
bilirubin
Orange-yellow pigment in bile; formed by the breakdown of hemoglobin when red blood cells
are destroyed.
coagulation
Blood clo ing.
colony-stimulating Protein factor that stimulates the growth and differentiation of developing blood cells.
factor (CSF)
Examples are granulocyte CSF, erythropoietin, and thrombopoietin.
differentiation
Change in structure and function of a cell as it matures; specialization.
electrophoresis
Method of separating serum proteins by electrical charge and size.
eosinophil
White blood cell containing granules that stain red; associated with allergic reactions.
erythroblast
Immature red blood cell.
erythrocyte
Red blood cell. There are about 5 million per microliter (µL) or cubic millimeter (mm3) of
blood.
erythropoietin
Hormone secreted by the kidneys; stimulates red blood cell formation.
(EPO)
fibrin
Protein that forms the basis of a blood clot.
fibrinogen
Plasma protein that is converted to fibrin in the clo ing process.
globulin
Plasma protein; alpha, beta, and gamma (immune) globulins are examples.
granulocyte
White blood cell with cytoplasmic granules: eosinophil, neutrophil, and basophil.
hematopoietic stem Cell in the bone marrow that gives rise to all types of blood cells.
cell
hemoglobin
Blood protein containing iron; carries oxygen in red blood cells.
heparin
Anticoagulant found in blood and tissue cells.
immune reaction
Response of the immune system to foreign invasion.
immunoglobulin
Protein (a globulin) with antibody activity; examples are IgG, IgM, IgA, IgE, IgD. Immun/o
means protection.
leukocyte
White blood cell.
lymphocyte
Mononuclear leukocyte that produces antibodies to fight disease.
macrophage
Monocyte that migrates from the blood to tissue spaces. As a phagocyte, it engulfs foreign
material and debris. In the liver, spleen, and bone marrow, macrophages destroy worn out red
blood cells and also engulf bacteria and other harmful organisms.
megakaryocyte
Large platelet precursor cell found in the bone marrow.
monocyte
Leukocyte with one large nucleus. It is a cell that engulfs foreign material and debris.
Monocytes become macrophages as they leave the blood and enter body tissues.
mononuclear
Pertaining to a cell (leukocyte) with a single round nucleus; lymphocytes and monocytes are
mononuclear leukocytes.
myeloblast
Immature bone marrow cell that gives rise to granulocytes.
neutrophil
Granulocytic leukocyte formed in bone marrow. It is a phagocytic tissue-fighting cell. Also
called a polymorphonuclear leukocyte.
plasma
Liquid portion of blood; contains water, proteins, salts, nutrients, wastes, lipids, hormones,
and vitamins.
plasmapheresis
Removal of plasma from withdrawn blood. Collected cells are retransfused back into the
donor. Fresh-frozen plasma or salt solution is used to replace withdrawn plasma.
platelet
Small blood cell fragment that collects at sites of injury to begin the clo ing process.
polymorphonuclear Pertaining to a white blood cell with a multilobed nucleus; neutrophil.
prothrombin
Plasma protein; converted to thrombin in the clo ing process.
reticulocyte
Immature erythrocyte. A network (reticulum) of strands is seen after staining the cell with
special dyes.
Rh factor
Antigen on red blood cells of Rh-positive (Rh+) individuals. The factor was first identified in
the blood of a rhesus monkey.
serum
Plasma minus clo ing proteins and cells. Clear, yellowish fluid that separates from blood
when it is allowed to clot. It is formed from plasma, but does not contain protein-coagulation
factors.
stem cell
Unspecialized cell that gives rise to mature, specialized forms. A hematopoietic stem cell is
the progenitor for all different types of blood cells.
thrombin
Enzyme that converts fibrinogen to fibrin during coagulation.
thrombocyte
Platelet.
Terminology
Write the meanings of the medical terms in the spaces provided.
853
Combining Forms
COMBINING
MEANING
FORM
bas/o
base (alkaline, the
opposite of acid)
chrom/o
color
coagul/o
clo ing
cyt/o
eosin/o
erythr/o
cell
red, dawn, rosy
red
granul/o
hem/o
granules
blood
hemat/o
blood
hemoglobin/o hemoglobin
is/o
same, equal
kary/o
leuk/o
mon/o
nucleus
white
one, single
morph/o
myel/o
shape, form
bone marrow
neutr/o
nucle/o
phag/o
poikil/o
neutral (neither base
nor acid)
nucleus
eat, swallow
varied, irregular
sider/o
spher/o
iron
globe, round
thromb/o
clot
TERMINOLOGY
MEANING
basophil _______________________________________
The suffix -phil means a raction to. Granules in basophils are a racted to a
basic dye and stain dark blue.
hypochromic ____________________________________
Hypochromic anemia is marked by a decreased concentration of hemoglobin in
red blood cells.
anticoagulant ____________________________________
coagulopathy ____________________________________
cytology _______________________________________
eosinophil ______________________________________
erythroblast _____________________________________
-blast means immature.
granulocyte _____________________________________
hemolysis ______________________________________
Destruction or breakdown of red blood cells. See hemolytic anemia, page 488.
hematocrit ______________________________________
The suffix -crit means to separate. The hematocrit gives the percentage of red
blood cells in a volume of blood. See page 492.
hemoglobinopathy _______________________________
anisocytosis _____________________________________
An abnormality of red blood cells; they are of unequal (anis/o) size; -cytosis
means an increase in the number of cells.
megakaryocyte __________________________________
leukopenia ______________________________________
monocyte _______________________________________
The cell has a single, rather than a multilobed, nucleus.
morphology _____________________________________
myeloblast ______________________________________
The suffix -blast indicates an immature or embryonic cell.
myelodysplasia __________________________________
This is a preleukemic condition.
neutropenia _____________________________________
This term refers to neutrophils.
polymorphonuclear _______________________________
phagocyte _____________________________________
poikilocytosis ___________________________________
Irregularity in the shape of red blood cells. Poikilocytosis occurs in certain types
of anemia.
sideropenia _____________________________________
spherocytosis ____________________________________
In this condition, the erythrocyte has a round shape, making the cell fragile and
easily able to be destroyed.
thrombocytopenia ________________________________
Suffixes
854
SUFFIX MEANING
removal, a carrying
apheresis away
-blast
-cytosis
immature or
embryonic cell
abnormal condition
of cells (increase in
cells)
TERMINOLOGY
MEANING
plasmapheresis __________________________________
A centrifuge spins blood to remove plasma from the other parts of blood.
leukapheresis ____________________________________
plateletpheresis __________________________________
Note that the a of apheresis is dropped in this term. Platelets are removed from the
donor's blood (and used in a patient), and the remainder of the blood is reinfused into
the donor.
monoblast _____________________________________
macrocytosis ____________________________________
Macrocytes are erythrocytes that are larger (macro-) than normal.
microcytosis ____________________________________
Erythrocytes are smaller (micro-) than normal. Table 13-3 reviews terms related to
abnormalities of red blood cell morphology.
-emia
blood condition
leukemia _______________________________________
See page 490.
-gen
giving rise to;
fibrinogen ______________________________________
producing
Fibrin is a protein that forms the basis of a blood clot.
-globin
protein
hemoglobin _____________________________________
-globulin
immunoglobulin _________________________________
-lytic
pertaining to
thrombolytic therapy ______________________________
destruction
Used to dissolve clots.
-oid
derived, related to, or
myeloid ________________________________________
originating from
Myeloid progenitor cells give rise to developing erythrocytes, platelets,
granulocytes, and monocytes. See Figure 13-1.
lymphoid _____________________________________
Lymphoid progenitor cells in bone marrow give rise to developing
lymphocytes.
-osis
abnormal condition thrombosis ______________________________________
-penia
deficiency
granulocytopenia _________________________________
pancytopenia ____________________________________
-phage
eat, swallow
macrophage _____________________________________
Large phagocyte that destroys worn out RBCs and foreign materials.
-philia
a raction for (an
eosinophilia _____________________________________
increase in cell
neutrophilia _____________________________________
numbers)
-phoresis carrying,
electrophoresis __________________________________
transmission
-poiesis formation
hematopoiesis ___________________________________
erythropoiesis ___________________________________
Erythropoietin is produced by the kidneys to stimulate erythrocyte formation.
myelopoiesis ____________________________________
-stasis
stop, control
hemostasis ______________________________________
TABLE 13-3
ABNORMALITIES OF RED BLOOD CELL MORPHOLOGY
ABNORMALITY
Anisocytosis
Hypochromia
Macrocytosis
Microcytosis
Poikilocytosis
Spherocytosis
DESCRIPTION
Cells are unequal in size
Cells have reduced color (less hemoglobin)
Cells are large
Cells are small
Cells are irregularly shaped
Cells are spherical (loss of normal concave shape)
Don't Confuse -apheresis with -phoresis
The suffix -apheresis refers to the removal of blood from a donor with a portion separated
and retained and the remainder reinfused into the donor (see page 494). The suffix phoresis indicates transmission (as in electrophoresis, the transmission of electricity to
separate substances).
855
Pathology
Any abnormal or pathologic condition of the blood generally is referred to as a blood
dyscrasia (disease). The blood dyscrasias discussed in this section are organized in the
following order: diseases of red blood cells, disorders of blood clo ing, diseases of white
blood cells, and diseases of the bone marrow.
Diseases of Red Blood Cells
856
anemia
Deficiency in erythrocytes or hemoglobin.
The most common type of anemia is iron deficiency anemia; it is caused by a lack of iron,
which is required for hemoglobin production (Figure 13-10).
Other types of anemia include:
1. aplastic anemia
Failure of blood cell production in the bone marrow.
The cause of most cases of aplastic anemia is unknown (idiopathic), but some have been
linked to benzene exposure and rarely to antibiotics such as chloramphenicol. Pancytopenia
occurs when stem cells fail to produce leukocytes, platelets, and erythrocytes. Blood
transfusions prolong life, allowing the marrow time to resume its normal functioning, and
antibiotics control infections. Bone marrow transplantation and regimens of drugs that
inhibit the immune system are successful treatments in cases in which spontaneous recovery
is unlikely.
2. hemolytic
Reduction in red cells due to excessive destruction.
anemia
One example of hemolytic anemia is congenital spherocytic anemia (hereditary
spherocytosis). Instead of their normal biconcave shape, erythrocytes become spheroidal.
This rounded shape makes them fragile and easily destroyed (hemolysis). Shortened red cell
survival results in increased reticulocytes in blood as the bone marrow compensates for
hemolysis of mature erythrocytes. Because the spleen destroys red cells, removal of the
spleen usually improves this anemia. Figure 13-11 shows the altered shape of erythrocytes in
hereditary spherocytosis.
3. sickle cell
Hereditary disorder of abnormal hemoglobin producing sickle-shaped erythrocytes and
anemia
hemolysis.
The crescent, or sickle, shape of the erythrocyte (see Figure 13-11) is caused by an abnormal
type of hemoglobin (hemoglobin S) in the red cell. Sickled red blood cells are sticky and form
globs that block blood flow. Serious complications include clo ing, stroke, and less flow of
blood through the lungs with poor oxygenation. Signs and symptoms are arthralgias, acute
a acks of abdominal pain, and ulcerations of the extremities. The genetic defect (presence of
the hemoglobin S gene) is particularly prevalent among people of African or Hispanic
ancestry and appears with different degrees of severity. Persons with the sickle cell trait
inherit just one gene for the disorder and usually do not have symptoms. Gene therapy for
sickle cell anemia (correcting the mutation in hematopoietic stem and progenitor cells in
bone marrow) is an exploratory treatment.
4. thalassemia
Inherited disorder of abnormal hemoglobin production leading to hypochromia.
A defect in a gene affects production of globin, the protein that is the major component of
hemoglobin. This condition, usually occurring in persons of Mediterranean or Asian
background, manifests in varying forms and degrees of severity and usually leads to
hypochromic anemia with diminished hemoglobin content in red cells (see Figure 13-11).
Thalassa is a Greek word meaning sea.
5. pernicious
Lack of mature erythrocytes caused by inability to absorb vitamin B12 into the
anemia
bloodstream.
Vitamin B12 is necessary for the proper development and maturation of erythrocytes. It is
common in a variety of foods, but it cannot be absorbed into the bloodstream without the aid
of a special substance called intrinsic factor, normally found in gastric juice. People with
pernicious anemia lack this factor, and the result is unsuccessful maturation of red blood
cells, with an excess of large, immature, and poorly functioning cells in the bone marrow and
large, often oval, red cells (macrocytes) in the circulation. Treatment is injection or oral
administration of vitamin B12 for life. Figure 13-11 illustrates cells in pernicious anemia.
Pernicious means harmful or dangerous. This type of anemia was named before we knew its
cause and how to treat it. Then, it was nearly always fatal within 6 months.
hemochromatosis
Excess iron deposits throughout the body.
Common signs and symptoms may include skin pigmentation, joint pain, and fatigue.
Without timely treatment, serious problems such as cirrhosis, diabetes, and cardiac failure
may occur. This condition can be hereditary or caused by frequent blood transfusions for a
chronic blood condition.
polycythemia
General increase in red blood cells (erythremia).
vera
Blood consistency is viscous (thick) because of greatly increased numbers of erythrocytes.
The bone marrow is hyperplastic, and leukocytosis and thrombocytosis commonly
accompany the increase in red blood cells. Treatment consists of reduction of red cell volume
to normal levels by phlebotomy (removal of blood from a vein) and by suppressing blood
cell production with myelotoxic drugs.
857
FIGURE 13-10 Normal red blood cells and iron deficiency anemia. A, Normal red
cells. Erythrocytes are fairly uniform in size and shape. The red cells are normal in
hemoglobin content (normochromic) and size (normocytic). B, Iron deficiency anemia.
Many erythrocytes are small (microcytic) and have increased central pallor
(hypochromic). Red cells in this slide show variation in size (anisocytosis) and shape
(poikilocytosis).
FIGURE 13-11 Normal red blood cells and the abnormal cells in several types of
anemia.
Disorders of Blood Clotting
hemophilia
purpura
Excessive bleeding caused by hereditary lack of factors VIII or IX necessary for blood clo ing.
Although the platelet count of a hemophiliac patient is normal, deficiency in clo ing factors (factor
VIII or IX) results in a prolonged coagulation time. Patients with clo ing factor deficiencies often
bleed into weight-bearing joints, especially ankles and knees. Treatment consists of administration
of the deficient factors. Progress is being made in treating hemophilia with gene therapy.
Multiple pinpoint hemorrhages and accumulation of blood under the skin.
Hemorrhages into the skin and mucous membranes produce reddish or bluish discoloration of the
skin. Lesions appear with increasing volume of bleeding. Petechiae are small, pinpoint purple or
red spots on the skin while ecchymoses are larger, blue or purplish bruises. (See Figure 13-12).
Purpura can result from a deficiency of platelets (thrombocytopenic purpura). The cause may be
immunologic, meaning that the body produces an antiplatelet factor that harms its own platelets
(autoimmune thrombocytopenic purpura). Treatments are splenectomy (the spleen is the site of
platelet destruction) and drug therapy to decrease the immune response.
858
FIGURE 13-12 A, Petechiae result from bleeding from capillaries or small arterioles. B,
Ecchymoses are larger and more extensive than petechiae.
Sickle Cell Trait and Malaria
People who have sickle cell trait (with one mutated gene) are more resistant to malaria
than people without the trait. Thus resistance to malaria allows people with the sickle cell
trait to live longer, reproduce, and pass the inherited sickle cell trait to future generations.
Why Hemophilia Mainly Affects Males
Because the genes for factors VIII and IX are on the X chromosome, hemophilia mainly
affects males. Males only have one X chromosome. In females, hemophilia rarely occurs
because typically one of their two X chromosomes is normal and it compensates for the
defective gene if it is on the other X chromosome.
Diseases of White Blood Cells
859
leukemia
Increase in malignant white blood cells (leukocytes).
Acute leukemias have common clinical characteristics: abrupt onset of signs and symptoms—
fatigue, fever, bleeding, bone pain, lymphadenopathy, splenomegaly, and hepatomegaly. If the
disease has spread to the spinal canal, headache and vomiting also may occur. In addition,
because normal blood cells are crowded out, patients have li le defense against infection.
Four types of leukemia are:
1. Acute myeloid (myelocytic) leukemia (AML). Immature granulocytes (myeloblasts) predominate.
Platelets and erythrocytes are diminished because of infiltration and replacement of the bone
marrow by large numbers of myeloblasts (Figure 13-13A).
Acute leukemia. A, Acute myeloid leukemia (AML). Myeloblasts (immature granulocytes)
predominate. There are large cells with small granules in their cytoplasm. AML affects primarily adults. A
majority of patients achieve remission with intensive chemotherapy, but relapse is common. Hematopoietic
stem cell transplantation may be a curative therapy. B, Acute lymphoid leukemia (ALL). Lymphoblasts
(immature lymphocytes) predominate. ALL is a disease of children and young adults. Most children are
cured with chemotherapy. (Courtesy Dr. Robert W. McKenna, Department of Pathology, University of Texas Southwestern
FIGURE 13-13
Medical School, Dallas.)
2. Acute lymphoid (lymphocytic) leukemia (ALL). Immature lymphocytes (lymphoblasts)
predominate. This form is seen most often in children and adolescents; onset is sudden (see Figure
13-13B).
3. Chronic myeloid (myelocytic) leukemia (CML). Both mature and immature granulocytes are
present in large numbers in the marrow and blood. This is a slowly progressive illness with which
patients (often adults older than 55) may live for many years without encountering life-threatening
problems. New therapies (such as the drug Gleevec) target abnormal proteins responsible for
malignancy and produce long-term control.
4. Chronic lymphoid (lymphocytic) leukemia (CLL). Abnormal numbers of relatively mature
lymphocytes predominate in the marrow, lymph nodes, and spleen. This most common form of
leukemia usually occurs in the elderly and follows a slowly progressive course. It often does not
require immediate treatment.
All forms of leukemia are treated with chemotherapy and targeted therapy. Drugs are used to
selectively injure rapidly dividing cells and interfere with signaling pathways in cells. Effective
treatment can lead to a remission (disappearance of signs and symptoms of disease). Relapse
occurs when disease symptoms and signs reappear, necessitating further treatment.
Transplantation of normal bone marrow from donors of similar tissue type is successful in
restoring normal bone marrow function in some patients with acute leukemia. This procedure is
performed after high-dose chemotherapy, which is administered to eliminate the leukemic cells.
granulocytosis
Abnormal increase in granulocytes in the blood.
An increase in neutrophils in the blood may occur in response to infection or inflammation of
any type. Eosinophilia is an increase in eosinophilic granulocytes, seen in certain allergic
conditions, such as asthma, or in parasitic infections (tapeworm, pinworm). Basophilia is an
increase in basophilic granulocytes seen in certain types of leukemia.
mononucleosis
Infectious, viral disease marked by increased numbers of mononuclear leukocytes and
enlarged cervical lymph nodes.
This disease is transmi ed by the Epstein-Barr virus (EBV). Lymphadenitis is present, with
fever, fatigue, asthenia (weakness), and pharyngitis. Atypical lymphocytes are present in the
blood, liver, and spleen (leading to hepatomegaly and splenomegaly).
Mononucleosis usually is transmi ed by direct oral contact (salivary exchange during kissing)
and affects primarily young adults. No treatment is necessary for EBV infections. Antibiotics are
not effective for self-limited viral illnesses. Rest during the period of acute symptoms and slow
return to normal activities are advised.
Disease of Bone Marrow Cells
860
multiple
myeloma
Malignant neoplasm of bone marrow.
Malignant cells, lymphocytes called plasma cells, produce antibodies that destroy bone tissue and
cause of immunoglobulins, including Bence Jones protein, an immunoglobulin fragment found in
urine. The condition leads to osteolytic lesions, hypercalcemia, anemia, renal damage, and increased
susceptibility to infection. Treatment is with analgesics, various doses of chemotherapy, and special
orthopedic supports. Drugs are used as palliative treatment (relieving symptoms) and to stop disease
progression. Autologous bone marrow transplantation (ABMT), in which the patient serves as his or
her own donor for stem cells, may lead to prolonged remission.
861
Laboratory Tests and Clinical Procedures
Laboratory Tests
antiglobulin
(Coombs) test
complete
blood count
(CBC)
erythrocyte
sedimentation
rate (ESR)
hematocrit
(Hct)
hemoglobin
test (H, Hg,
Hgb, HGB)
platelet count
prothrombin
time (PT)
red blood cell
count (RBC)
red blood cell
morphology
white blood
cell count
(WBC)
white blood
cell
differential
[count]
Test for the presence of antibodies that coat and damage erythrocytes.
This test determines the presence of antibodies in infants of Rh-negative women or in patients
with autoimmune hemolytic anemia. It is also a screening test for blood transfusion
compatibility.
Determination of numbers of blood cells, hemoglobin concentration, hematocrit, and red cell
values—MCH, MCV, MCHC (see Abbreviations).
Speed at which erythrocytes se le out of plasma.
Venous blood is collected into an anticoagulant, and the blood is placed in a tube in a vertical
position. The distance that the erythrocytes sink in a given period of time under the influence of
gravity alone is the sedimentation rate. The rate increases with infections, joint inflammation,
and tumor, which increase the fibrinogen content of the blood. Also called sed rate for short.
Percentage of erythrocytes in a volume of blood.
A sample of blood is spun in a centrifuge so that the erythrocytes fall to the bo om of the
sample.
Total amount of hemoglobin in a sample of peripheral blood.
Number of platelets per cubic millimeter (mm3) or microliter (µL) of blood.
Platelets normally average between 150,000 and 450,000 per mm3 (cu mm) or µL.
Test of the ability of blood to clot.
Prothrombin is one of the clo ing factors (factor II) made by the liver. This test is used to
monitor (follow) patients taking certain anticoagulant drugs. The INR (international
normalized ratio) is the ratio of patient's prothrombin time compared with standard
prothrombin time obtained across the United States and the world. It is normally near 1. Patients
on the anticoagulant drug warfarin are maintained at INRs of 2 to 3. Another blood clo ing test,
partial thromboplastin time (PTT), measures other clo ing factors. Both PT and PTT are often
done at the same time to check for bleeding problems.
Number of erythrocytes per cubic millimeter (mm3) or microliter (µL) of blood.
The normal number is 4 million to 6 million per mm3 (or µL).
Microscopic examination of a stained blood smear to determine the shape of individual red
cells.
Abnormal morphology includes anisocytosis, poikilocytosis, microcytosis, macrocytosis, and
sickle cells.
Number of leukocytes per cubic millimeter (mm3) or microliter (µL) of blood.
Automated counting devices record numbers within seconds. Normal number of leukocytes
averages between 7000 and 10,000 per mm3 (or µL).
Percentages of different types of leukocytes in the blood.
Some instruments can produce an automated differential count, but otherwise the cells are
stained and counted under a microscope by a technician. Percentages of neutrophils,
eosinophils, basophils, monocytes, lymphocytes, and immature cells (bands) are determined.
See page 498 for the normal differential values.
The term shift to the left describes an increase in immature neutrophils in the blood.
Shift to the Left
The phrase “shift to the left” derives from the early practice of reporting percentages of
each WBC type across the top of a page, starting with blasts (immature cells) on the left
and more mature cells on the right. An increase in immature neutrophils (as seen with
severe infection) would be seen in the left-hand column of the reporting form. This “shift
to the left” indicates an infection and reflects the body's effort to fight it by making more
neutrophils.
Clinical Procedures
862
apheresis
blood
transfusion
bone marrow
biopsy
hematopoietic
stem cell
transplantation
Separation of blood into component parts and removal of a select portion from the blood.
This procedure can remove toxic substances or autoantibodies from the blood and can collect
blood cells. Leukapheresis, plateletpheresis, and plasmapheresis are examples (Figure 13-14). If
plasma is removed from the patient and fresh plasma is given, the procedure is termed plasma
exchange.
Whole blood or cells are taken from a donor and infused into a patient.
Appropriate testing to ensure a match of red blood cell type (A, B, AB, or O) is essential. Tests
also are performed to detect the presence of hepatitis and the acquired immunodeficiency
syndrome (AIDS) virus (HIV). Autologous transfusion is the collection and later reinfusion of
a patient's own blood or blood components. Packed cells are a preparation of red blood cells
separated from liquid plasma and administered in severe anemia to restore levels of
hemoglobin and red cells without overdiluting the blood with excess fluid.
Microscopic examination of a core of bone marrow removed with a needle.
This procedure is helpful in the diagnosis of blood disorders such as anemia, pancytopenias,
and leukemia. Bone marrow also may be removed by brief suction produced by a syringe,
which is termed a bone marrow aspiration. See Figure 13-15.
Peripheral stem cells from a compatible donor are administered to a recipient.
Patients with malignancies, such as AML, ALL, CLL, CML, lymphoma, multiple myeloma, as
well as patients with severe autoimmune diseases are candidates for this treatment. First the
donor is treated with a drug that mobilizes stem cells into the blood. Then stem cells are
removed from the donor, a process like leukapheresis in Figure 13-14. Meanwhile, the patient
(recipient) undergoes a conditioning process in which radiation and chemotherapy drugs are
administered to kill malignant marrow cells and inactivate the patient's immune system so that
subsequently infused stem cells will not be rejected. A cell suspension containing the donor's
stem cells, which will repopulate the bone marrow, is then given through a vein to the
recipient. In autologous stem cell transplantation, the patient's own stem cells are collected,
stored, and reinfused after potent chemotherapy. See In Person: Autologous Stem Cell
Transplant, page 499.
Bone marrow transplantation follows the same procedure, except that bone marrow cells are
used rather than peripheral stem cells (Figure 13-16). Problems encountered subsequently may
include serious infection, graft-versus-host disease (GVHD), and relapse of the original
disease despite the treatment.
In GVHD, the immunocompetent cells in the donor's tissue recognize the recipient's tissues as
foreign and a ack them. Because the recipient patient is totally immunosuppressed, his or her
immune system cannot defend against the a ack. Intensive prophylaxis (prevention) with
immunosuppressive drugs is standard for patients undergoing allogeneic transplants (see
Figure 13-16). These drugs include cyclosporine, methotrexate, glucocorticoids, sirolimus
(Rapamune), and mycophenolate.
FIGURE 13-14 Leukapheresis. This machine is an automated blood cell separator
that removes large numbers of white blood cells and returns red cells, platelets, and
plasma to the patient.
863
FIGURE 13-15 Bone marrow aspiration and biopsy. A, Placement of a bone marrow
needle into the iliac crest (upper portion of hipbone) and aspiration of liquid bone
marrow. B, Trephine needle is then inserted and anchored in the bone. C, A solid piece
of bone marrow (biopsy sample) is then extracted through the needle.
FIGURE 13-16 Hematopoietic stem cell and bone marrow transplantation. These
procedures constitute allogeneic (all/o means other, different) transplantation, in which
a relative or an unrelated person with a close or identical HLA (human leukocyte
antigen) type is the donor. It carries a risk of morbidity (disease) and mortality (death)
because of complications of incompatibility such as GVHD (graft-versus-host disease).
In an autologous transplantation, stem cells or bone marrow cells are removed from
the patient during a remission phase and given back to the patient after intensive
chemotherapy (drug treatment).
864
Abbreviations
Ab
ABMT
ABO
ALL
AML
ANC
antibody
autologous bone marrow transplantation—patient serves as his or her own donor for stem cells
four main blood types—A, B, AB, and O
acute lymphoid leukemia
acute myeloid leukemia
absolute neutrophil count—total WBC times a measure of the number of bands and segs present in
the blood; an ANC less than 1500 cells/uL is neutropenia
ASCT
autologous stem cell transplantation
bands
immature white blood cells (granulocytes)
baso
basophils
BMT
bone marrow transplantation
CBC
complete blood count
CLL
chronic lymphoid leukemia
CML
chronic myeloid leukemia
DIC
disseminated intravascular coagulation—bleeding disorder marked by reduction in blood clo ing
factors
diff
differential count (white blood cells)
EBV
Epstein-Barr virus; cause of mononucleosis
eos
eosinophils
EPO
erythropoietin
ESR
erythrocyte sedimentation rate
Fe
iron
G-CSF
granulocyte colony-stimulating factor—promotes neutrophil production
GM-CSF
granulocyte-macrophage colony-stimulating factor—promotes myeloid progenitor cells with
differentiation to granulocytes
g/dL
gram per deciliter (1 deciliter = one tenth of a liter or just over 3 ounces.
GVHD
graft-versus-host disease—immune reaction of donor's cells to recipient's tissue
HCL
hairy cell leukemia—abnormal lymphocytes accumulate in bone marrow, leading to anemia,
thrombocytopenia, neutropenia, and infection
Hct
hematocrit
Hgb, HGB
hemoglobin
H and H
hemoglobin and hematocrit
HLA
human leukocyte antigen
IgA, IgD, IgE, immunoglobulins
IgG, IgM
INR
international normalized ratio--ratio of a patient's prothrombin time compared to a standard
prothrombin time, used to monitor anticoagulation (warfarin) therapy.
ITP
idiopathic thrombocytopenic purpura
lymphs
lymphocytes
MCH
mean corpuscular hemoglobin—average amount of hemoglobin per cell
MCHC
mean corpuscular hemoglobin concentration—average concentration of hemoglobin in a single red
cell; when MCHC is low, the cell is hypochromic
MCV
mean corpuscular volume—average volume or size of a single red blood cell; when MCV is high, the
cells are macrocytic, and when low, the cells are microcytic
µL
microliter—one millionth of a liter; 1 liter = 1.057 quarts
MDS
myelodysplastic syndrome—preleukemic condition (anemia, cytopenias, and possible
transformation to AML)
cubic millimeter—one millionth of a liter; 1 liter = 1.057 quarts
mm3
mono
monocyte
polys, PMNs, polymorphonuclear leukocytes; neutrophils, eosinophils, basophils
PMNLs
PT, pro time prothrombin time
PTT
partial thromboplastin time
RBC
red blood cell; red blood cell count
sed rate
erythrocyte sedimentation rate
segs
segmented, mature white blood cells (neutrophils)
SMAC
Sequential Multiple Analyzer Computer—an automated chemistry system that determines
substances in serum
WBC
white blood cell; white blood cell count
WNL
within normal limits
865
Practical Applications
The cases presented here are based on data from actual medical records. Use the table of
normal values on the next page to help you decide on a probable diagnosis. Answers to the
questions are on page 508.
Case Report
Four-year-old Sally has been running a low-grade fever for several weeks, with recurrent
sore throat, earache, and cough. Her mother takes her to the family physician, who
diagnoses her condition as otitis. Sally continues to be fatigued and anorexic. Her mother
then notices bruising on her legs and arms. The family physician finally orders blood tests
and an antibiotic drug. Peripheral blood tests reveal Hgb 7.4, platelet count 40,000, and
WBC count 85,000 with 90% lymphoblasts. A bone marrow biopsy is ordered.
1. What's the likely diagnosis for this patient?
a. AML
b. CLL
c. ALL
d. CML
2. The probable cause of Sally's ecchymoses is:
a. Neutropenia
b. Thrombocytopenia
c. Anorexia
d. Otitis
3. The likely explanation for Sally's fatigue is:
a. Anemia
b. Sore throat and cough
c. Thrombocytopenia
d. Neutropenia
4. Treatment for Sally's condition is likely to be:
a. Prolonged antibiotic therapy
b. Intravenous feeding
c. Surgery to repair the bone marrow
d. Chemotherapy
Use the table of normal values to help you decide on a probable diagnosis in each case.
Normal Laboratory Values
WBC 4500-11,000/mm3 or µL
Differential
Segs (polys)
Lymphs
Eos
Baso
Mono
RBC
54-62%
20-40%
1-3%
0-1%
3-7%
M:
4.5-6.0 million per mm3 or µL
F:
4.0-5.5 million per mm3 or µL
Hct
M:
40-50%
F:
37-47%
Hgb
M:
14-16 g/dL
F:
12-14 g/dL
Platelets 150,000-350,000/mm3 or µL
Five Short Clinical Cases
1. A 65-year-old woman visits her physician complaining of shortness of breath and
swollen ankles. Lab tests reveal that her hematocrit is 18.0 and her hemoglobin 5.8.
Her blood smear shows macrocytes and her blood level of vitamin B12 is very low.
What is a likely diagnosis?
a. Aplastic anemia
b. Hemochromatosis
866
c. Pernicious anemia
2. A 22-year-old college student visits the clinic with a fever, complaining of a sore
throat. Blood tests show a WBC of 28,000 per mm3 with 95% myeloblasts (polys are
5%). Platelet count is 15,000 per mm3, hemoglobin is 10 g/dL, and hematocrit is 22.5.
What is your diagnosis?
a. Chronic lymphoid leukemia
b. Acute myeloid leukemia
c. Thalassemia
3. A 35-year-old woman goes to her physician complaining of spots on her legs and
bleeding gums. On examination, she has tiny purple spots covering her legs and
evidence of dried blood in her mouth. Her CBC shows hemoglobin 14 g/dL,
hematocrit 42%, WBC 5000/mm3 with normal differential [count], and platelet count
4000/mm3 (with megakaryocytes in bone marrow). What is your diagnosis?
a. Sickle cell anemia
b. Hemolytic anemia
c. Autoimmune thrombocytopenic purpura
4. A 55-year-old man is admi ed to the hospital after a motorcycle crash. He sustained
right hemopneumothorax (blood and air in the chest cavity) requiring placement of
a chest tube. His admission hemoglobin was 11.4 g/dL and his hematocrit was 33.7%.
On the third day of hospitalization, his hemoglobin dropped to 7.5 g/dL and his
hematocrit fell to 22.4%. What do you think his physician should order?
a. Bone marrow aspiration and biopsy
b. Transfusion of packed red blood cells
c. Leukapheresis
5. A 45-year-old woman has recently been traveling internationally and comes to the ED
complaining of diarrhea, vomiting, and severe abdominal pain lasting for the
previous 2 weeks. Her total WBC was elevated. Stool cultures reveal a parasitic
infection. Which element of the differential do you expect to be elevated?
a. Eosinophils
b. Monocytes
c. Segs (polys)
In Person
Autologous Stem Cell Transplant
I was scheduled for a stem cell transplant to cure my recurrent primary central nervous
system lymphoma, or PCNSL, a rare type of brain cancer. Until around 15 years ago, stem
867
cell transplants depended upon bone marrow from which to harvest the cells. Since then,
scientists have discovered that there are actually more cells available in peripheral
(circulating) blood than in marrow. I was given two medicines, Mozobil and Neupogen,
aimed at stimulating enough stem cells to be collected from that peripheral source. In a
peripheral autologous blood stem cell transplant, stem cells are collected from the
circulating blood by apheresis, in which blood is withdrawn through a sterile needle, and
passed through a machine that harvests stem cells into a container, while the remaining
blood components are then transferred back into the patient's bloodstream. The fraction
containing the blood stem cells is then frozen until needed for transplantation. Because
patients get their own cells back, no chance exists for immune mismatch or graft-versushost problems.
On the first day of stem cell collection, I produced half of the total stem cells I would
need for my treatment. By the end of the third day of collection, I had reached the magic
number of stem cells needed, and was able to go home to wait for the hospital to schedule
me for the transplant. A representative phoned 2 days later, laying out the next 5 weeks for
me: I'd be admi ed in 11 days to the transplant division, where I would remain, they
hoped, for no more than a month. My (presumably clean) stem cells were safely stored in a
freezer while I was to undergo intensive chemotherapy meant to destroy any lurking
cancer cells in my brain (and of course, benign others in the medicine's “take-no-prisoners”
path).
I was glad when the date arrived, and my husband Dennis moved me into my next
month's home on the eighth floor of the hospital. What I had failed to understand is the
nature of an autologous stem cell transplant, at least for primary CNS lymphoma. I was to
be blasted, rendered helpless, with a trio of chemo agents able to pass through the bloodbrain barrier, but not ordinarily available for treatment-as-a-threesome due to their
combined viciousness: busulfan, thiotepa (mustard gas–related), and cyclophosphamide
(also a nitrogen mustard alkylating agent). I could risk receiving these killers because my
uncontaminated stem cells were stored in the freezer. They would eventually replace my
currently circulating blood that was being saturated with chemotherapy agents.
After 9 days, my white blood count was as low as it could go: I was at ground zero, “my
second birthday.” The blood we'd collected with the help of Mozobil and company was
slowly thawed, for a few hours, and soon I was given a transfusion of my previously
frozen blood, swarming with stem cells. Before long, I felt so sick I thought I was dying.
Wearing diapers that had to be changed every 20 minutes, having rectal samples taken
from my chafed, sometimes bloody “toilet skin” (as the nurse called it), being forced to sit
up every minute, even at night, so that I could put the suction tube down my throat to
keep from drowning in the rope-like mucositis, which ulcerated the membranes lining my
digestive system—I could go on and on.
But as I'd been promised, nearly 5 weeks post-admission for the life-giving stem cell
transplant, I was deemed ready to go home. For a month, however, our house operated
like a medical office. That first week, I kept down half a shake a day. When I returned for
my first checkup, I had to stay an extra 5 hours for a hydration infusion. Four days later,
my red blood count was low and I needed a transfusion. By the second week, I'd started
eating Cheerios with milk throughout the day, and my weight at least stabilized. I no
longer looked like a skeleton.
At 100 days post-transplant, we could make love again. I worried that Dennis would
find my scrawniness a turnoff, but he accepted my new “boy's body” and enthusiastically
helped me recapture my faith in our oneness. After all, we'd been through the ba le and
needed now to smell the perennial flowers. Turns out they're as colorful as ever.
Laura Claridge Oppenheimer is a writer with Farrar, Straus and Giroux. She just
finished a novel, Loving Hard. Her latest non-fiction book is The Lady with the Borzoi, a
biography of publisher Blanche Knopf.
868
Exercises
Remember to check your answers carefully with the Answers to Exercises, page 506.
A Match the cells with their definitions.
basophil
eosinophil
erythrocyte
hematopoietic stem cell
lymphocyte
monocyte
neutrophil
platelet
1. mononuclear white blood cell formed in lymph tissue; it is a
phagocyte and the precursor of a macrophage
______________________
2. thrombocyte or cell fragment that helps blood clot
______________________
3. cell in the bone marrow that gives rise to different types of blood
cells ______________________
4. mononuclear leukocyte formed in lymph tissue; produces
antibodies ______________________
5. leukocyte with dense, reddish granules having an affinity for red
acidic dye; associated with allergic reactions
______________________
6. red blood cell ______________________
7. leukocyte (polymorphonuclear granulocyte) formed in the bone
marrow; granules do not stain intensely and have a pale color
______________________
8. leukocyte (granulocyte) with dark-staining blue granules; releases
histamine and heparin _____________________
B Give the meanings of the following terms.
1. coagulation
________________________________________________________
2. granulocyte
_________________________________________________________
3. mononuclear
_________________________________________________________
869
4. polymorphonuclear
_________________________________________________________
5. globulin
_________________________________________________________
6. erythroblast
_________________________________________________________
7. megakaryocyte
_________________________________________________________
8. macrophage
_________________________________________________________
9. hemoglobin
_________________________________________________________
10. plasma
_________________________________________________________
11. myeloblast
_________________________________________________________
C Match the listed terms with the descriptions/definitions that
follow.
albumin
antibody
antigen
bilirubin
colony-stimulating factor
differentiation
erythropoietin
fibrinogen
globulin
heparin
plasma
serum
1. liquid portion of blood ________________________
2. orange-yellow pigment produced from hemoglobin when red
blood cells are destroyed ________________________
3. plasma protein converted to fibrin in clo ing process
________________________
4. proteins in plasma; separated into alpha, beta, and gamma types
________________________
870
5. hormone secreted by the kidneys to stimulate bone marrow to
produce red blood cells ________________________
6. substance (usually foreign) that stimulates production of an
antibody ______________________
7. protein in blood that maintains the proper amount of water in the
blood ___________________
8. specific protein produced by lymphocytes in response to antigens
in the blood _______________
9. anticoagulant found in blood and tissue cells
________________________
10. plasma minus clo ing proteins and cells
________________________
11. change in structure and function of a cell as it matures
________________________
12. protein that stimulates growth of developing blood cells
________________________
D Give short answers for the following.
1. Name four types of plasma proteins.
__________________________________________________
2. What is the Rh factor?
__________________________________________________________
___
3. What is hemolysis?
__________________________________________________________
_____
4. A person with type A blood has ________ antigens and ________
antibodies in his or her blood.
5. A person with type B blood has ________ antigens and ________
antibodies in his or her blood.
6. A person with type O blood has ________ antigens and ________
antibodies in his or her blood.
7. A person with type AB blood has ________ antigens and _______
antibodies in his or her blood.
8. Can you transfuse blood from a type A donor into a type B
recipient? _________ Why or why not?
__________________________________________________________
______________________
871
9. Can you transfuse blood from a type AB donor into a type O
recipient? Why or why not?
__________________________________________________________
______________________
10. What is electrophoresis?
_______________________________________________________
11. What is an immunoglobulin?
_______________________________________________________
12. What is differentiation?
__________________________________________________________
__
13. What is plasmapheresis?
__________________________________________________________
_
14. Why is a person with type O blood the universal donor?
_________________________________
E Match the listed terms related to clo ing with the
descriptions/definitions that follow.
coagulation
fibrin
fibrinogen
heparin
prothrombin
serum
thrombin
warfarin (Coumadin)
1. anticoagulant substance found in liver cells, blood, and tissues
________________________
2. protein thread that forms the basis of a blood clot
________________________
3. plasma protein that is converted to thrombin in the clo ing
process _______________________
4. plasma minus clo ing proteins and cells
________________________
5. drug given to patients to prevent formation of clots
________________________
872
6. plasma protein that is converted to fibrin in the clo ing process
________________________
7. process of clo ing ________________________
8. enzyme that helps convert fibrinogen to fibrin
________________________
F Divide the following terms into component parts and give the
meanings of the complete terms.
1. anticoagulant
__________________________________________________________
__________
2. hemoglobinopathy
__________________________________________________________
______
3. cytology
__________________________________________________________
___________
4. leukopenia
__________________________________________________________
___________
5. morphology
__________________________________________________________
___________
6. megakaryocyte
__________________________________________________________
_________
7. sideropenia
__________________________________________________________
___________
8. phagocyte
__________________________________________________________
___________
9. myelopoiesis
__________________________________________________________
___________
10. plateletpheresis
__________________________________________________________
_________
11. monoblast
__________________________________________________________
873
___________
12. myelodysplasia
__________________________________________________________
_________
13. hemostasis
__________________________________________________________
___________
14. thrombolytic (therapy)
__________________________________________________________
___
15. hematopoiesis
__________________________________________________________
_________
G Match the hematology terms with their meanings.
coagulopathy
eosinophilia
hematocrit
leukapheresis
myeloid
neutropenia
thrombocytopenia
thrombosis
1. derived in bone marrow ________________________
2. deficiency of a type of white blood cell ________________________
3. percentage of red blood cells in a volume of blood
________________________
4. increase in a type of white blood cell (seen in allergies)
________________________
5. abnormal condition of clot formation ________________________
6. separation of white blood cells from a blood sample
________________________
7. disease of clo ing process ________________________
8. deficiency of platelets ________________________
H Match the listed terms concerning red blood cells with the
descriptions/definitions that follow.
anemia
874
anisocytosis
erythropoiesis
hematocrit
hemoglobin
hemolysis
hypochromic
macrocytosis
microcytosis
poikilocytosis
polycythemia vera
spherocytosis
1. any irregularity in the shape of red blood cells
________________________
2. oxygen-containing protein in red blood cells
________________________
3. formation of red blood cells ________________________
4. deficiency in numbers of red blood cells
________________________
5. destruction of red blood cells ________________________
6. pertaining to reduction of hemoglobin in red blood cells
________________________
7. variation in size of red blood cells ________________________
8. abnormal numbers of round, rather than normally biconcaveshaped, red blood cells ________________________
9. increase in number of small red blood cells
________________________
10. general increase in numbers of red blood cells; erythremia
________________________
11. increase in numbers of large red blood cells
________________________
12. separation of blood so that the percentage of red blood cells in
relation to the volume of a blood sample is measured
________________________
I Describe the problem in each of the following forms of anemia.
1. iron deficiency anemia
__________________________________________________________
___
875
2. pernicious anemia
__________________________________________________________
_____
3. sickle cell anemia
__________________________________________________________
_____
4. aplastic anemia
__________________________________________________________
_____
5. thalassemia
__________________________________________________________
_____
J Give the meanings of the following terms for blood dyscrasias.
1. purpura
__________________________________________________________
________________
2. granulocytosis
__________________________________________________________
__________
3. hemophilia
__________________________________________________________
____________
4. hemochromatosis
__________________________________________________________
________
5. multiple myeloma
__________________________________________________________
_______
6. mononucleosis
__________________________________________________________
__________
K Match the term in Column I with its meaning in Column II. Write
the le er of the meaning in the space provided.
876
COLUMN I
1. relapse
2. remission
3. palliative
4. Bence Jones protein
5. ecchymoses
6. pancytopenia
7. apheresis
8. eosinophilia
9. petechiae
10. packed cells
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
COLUMN II
A. Deficiency of all blood cells
B. Immunoglobulin fragment found in the urine of patients with multiple myeloma
C. Increase in numbers of granulocytes; seen in allergic conditions
D. Large blue or purplish patches on skin (bruises)
E. Symptoms of the disease return
F. Tiny purple or flat red spots on skin occurring as a result of small hemorrhages
G. Symptoms of the disease disappear
H. Separation of blood into its parts
I. Preparation of erythrocytes separated from plasma
J. Relieving but not curing
L Match the laboratory test or clinical procedure with its description.
antiglobulin (Coombs) test
autologous transfusion
bone marrow biopsy
erythrocyte sedimentation rate
hematocrit
hematopoietic stem cell transplantation
platelet count
red blood cell count
red blood cell morphology
white blood cell differential
1. microscopic examination of a stained blood smear to determine
the shape of individual red blood cells
__________________________________________________________
_________
2. percentage of red blood cells in a volume of blood
__________________________________
3. determines the number of clo ing cells per mm3 or µL of blood
_______________________
4. speed at which erythrocytes se le out of plasma
___________________________________
5. percentages of different types of leukocytes in the blood
______________________________
6. test for the presence of antibodies that coat and damage
erythrocytes ____________________
7. peripheral stem cells from a compatible donor are infused into a
recipient's vein to repopulate the bone marrow
__________________________________________________________
__
877
8. microscopic examination of a core of bone marrow removed with
a needle
__________________________________________________________
__________________________________________________________
________________________
9. number of erythrocytes per mm3 or µL of blood
___________________________________
10. blood is collected from and later reinfused into the same patient
______________________
M Circle the boldface terms that best complete the meaning of the
sentences.
1. Gary, a 1-year-old African American child, was failing to gain
weight normally. He seemed pale and without energy. His blood
tests showed a decreased hemoglobin (5.0 g/dL) and decreased
hematocrit (16.5%). After a blood smear revealed abnormally
shaped red cells, the physician told Gary's parents that their son
had (iron deficiency anemia, hemophilia, sickle cell anemia).
2. While in the hospital, Mr. Klein was told he had an elevated (red
blood cell, white blood cell, platelet) count with a “shift to the
left.” This was information that confirmed his diagnosis of a
systemic infection.
3. While Mr. Chen was taking warfarin (Coumadin), a blood thinner,
his physician made sure to check his (prothrombin time,
hematocrit, sed rate).
4. Sixty-one-year-old Barbara's laboratory tests showed abnormal
proteins in her plasma and Bence Jones protein in her urine. She
had osteopenia and a fracture in one of her ribs. Her oncologist
diagnosed her condition as (mononucleosis, thrombocytopenic
purpura, multiple myeloma). He prescribed analgesics and drugs
such as thalidomide and bortezomib (Velcade).
5. Bobby was diagnosed at a very early age with a bleeding disorder
called (hemophilia, thalassemia, eosinophilia). He needed factor
VIII regularly, especially after even the slightest traumatic injury.
6. Juan was a 9-year-old boy who suddenly noticed many black and
blue marks all over his legs. He had a fever and was tired all the
time. The physician did a blood test that revealed pancytopenia. A
bone marrow biopsy confirmed the diagnosis of (acute lymphoid
leukemia, polycythemia vera, aplastic anemia).
7. Alice and her friends had been staying up late for weeks,
cramming for exams. She developed a sore throat and swollen
878
lymph nodes in her neck and felt fatigued all the time. Dr. Smith
did a blood test, and the results showed lymphocytosis and
antibodies to EBV in the bloodstream. His diagnosis was
(leukapheresis, lymphocytopenia, mononucleosis).
8. Susan was experiencing heavy menstrual periods (menorrhea,
menorrhagia, hemoptysis). Because of the bleeding, she
frequently felt tired and weak and probably was sideropenic. Her
physician performed blood tests that revealed her problem as
(thrombocytopenia, pernicious anemia, iron deficiency anemia).
9. Dr. Harris examined a highly allergic patient and sent a blood
sample to a specialist, a (pulmonary, cardiovascular,
hematologic) pathologist. The specialist stained the blood smear
and found an abundance of leukocytes with dense, reddish
granules. She made the diagnosis of (basophilia, eosinophilia,
neutrophilia).
10. George's blood cell counts had been falling in recent weeks. His
scheduled laparotomy was canceled because blood tests revealed
(pancytopenia, plasmapheresis, myelopoiesis). Bone marrow
biopsy determined that the cause was (hyperplasia, hypoplasia,
differentiation) of all cellular elements.
N Spell out the abbreviations in Column I, and then select the best
description for each from the definitions in Column II.
COLUMN I
1. Hgb
___________________________
2. GVHD
_________________________
3. ALL
___________________________
4. PT
____________________________
5. CML
___________________________
6. EPO
__________________________
7. IgA, IgE, IgD ________________
8. CLL
___________________________
9. Hct
____________________________
10. AML
___________________________
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
COLUMN II
A. Blood protein that transports oxygen to tissues.
B. Malignant condition of white blood cells; immature granulocytes (myeloblasts)
predominate.
C. Malignant condition of white blood cells; immature lymphocytes predominate.
D. Test used to follow patients who are taking certain anticoagulants.
E. Percentage of red cells in blood volume.
F. Malignant condition of white blood cells in which both mature and immature
granulocytes are present; a slowly progressive illness.
G. Immune reaction of donor's cells/tissue to recipient's cells/tissue; a possible
outcome of hematopoietic stem cell or bone marrow transplantation.
H. Proteins containing antibodies.
I. Malignant condition of white blood cells in which relatively mature lymphocytes
predominate in lymph nodes, spleen, and bone marrow; usually seen in elderly
patients.
J. Hormone that stimulates the growth of red blood cells.
879
Answers to Exercises
A
1. monocyte
2. platelet
3. hematopoietic stem cell
4. lymphocyte
5. eosinophil
6. erythrocyte
7. neutrophil
8. basophil
B
1. blood clo ing
2. white blood cell with numerous, cytoplasmic granules (neutrophil,
basophil, and eosinophil)
3. pertaining to a leukocyte with a single round nucleus; monocytes
and lymphocytes are mononuclear leukocytes
4. pertaining to a white blood cell with a multilobed nucleus;
neutrophil
5. plasma protein; alpha, beta, and gamma (immune) globulins are
examples
6. immature red blood cell
7. large platelet precursor (forerunner) cell found in bone marrow
8. monocyte that migrates from blood to tissue spaces; phagocyte that
engulfs foreign material and ingests red blood cells
9. blood protein containing iron; carries oxygen in erythrocytes
10. liquid portion of blood
11. immature bone marrow cell that gives rise to granulocytes
C
1. plasma
2. bilirubin
880
3. fibrinogen
4. globulin
5. erythropoietin
6. antigen
7. albumin
8. antibody
9. heparin
10. serum
11. differentiation
12. colony-stimulating factor
D
1. albumin, globulins, fibrinogen, and prothrombin
2. an antigen normally found on red blood cells of Rh+ individuals
3. destruction or breakdown of red blood cells
4. A; anti-B
5. B; anti-A
6. no A or B; anti-A and anti-B
7. A and B; no anti-A and no anti-B
8. no; A antigens will react with the anti-A antibodies in the type B
recipient's bloodstream
9. no; A and B antigens will react with the anti-A and anti-B antibodies
in the type O recipient's bloodstream
10. method of separating serum proteins by electrical charge and size
11. protein with antibody activity; IgG, IgH, IgE
12. change in structure and function of a cell as it matures;
specialization
13. removal by centrifuge of plasma from withdrawn blood
14. type O blood does not contain A or B antigens and therefore will
not react with antibodies in any recipient's blood
E
881
1. heparin
2. fibrin
3. prothrombin
4. serum
5. warfarin (Coumadin)
6. fibrinogen
7. coagulation
8. thrombin
F
1. anti/coagul/ant—a substance that prevents clo ing
2. hemoglobin/o/pathy—disease (abnormality) of hemoglobin
3. cyt/o/logy—study of cells
4. leuk/o/penia—deficiency of white (blood) cells
5. morph/o/logy—study of the shape or form (of cells)
6. mega/kary/o/cyte—cell with a large (mega-) nucleus (kary); platelet
precursor
7. sider/o/penia—deficiency of iron
8. phag/o/cyte—cell that eats or swallows other cells
9. myel/o/poiesis—formation of bone marrow
10. platelet/pheresis—separation of platelets from the rest of the blood
11. mon/o/blast—immature monocyte
12. myel/o/dys/plasia—abnormal (ineffective) production of myeloid
cells in bone marrow. Myeloid progenitor cells give rise to
erythrocytes, granulocytes, and platelets
13. hem/o/stasis—controlling or stopping the flow of blood
14. thromb/o/lytic (therapy)—pertaining to treatment using drugs to
destroy clots
15. hemat/o/poiesis—formation of blood cells
G
1. myeloid
882
2. neutropenia
3. hematocrit
4. eosinophilia
5. thrombosis
6. leukapheresis
7. coagulopathy
8. thrombocytopenia
H
1. poikilocytosis
2. hemoglobin
3. erythropoiesis
4. anemia
5. hemolysis
6. hypochromic
7. anisocytosis
8. spherocytosis
9. microcytosis
10. polycythemia vera
11. macrocytosis
12. hematocrit
I
1. lack of iron leading to insufficient hemoglobin production
2. lack of mature erythrocytes caused by inability to absorb vitamin B12
into the bloodstream (intrinsic factor is missing in gastric juice, so B12
is not absorbed)
3. hereditary disorder of abnormal hemoglobin producing sickleshaped erythrocytes and hemolysis
4. failure of blood cell production in bone marrow
5. inherited disorder of abnormal hemoglobin production leading to
hypochromia
883
J
1. multiple pinpoint hemorrhages and accumulation of blood under
the skin (cause may be deficiency of platelets)
2. abnormal increase in granulocytes in the blood (eosinophilia and
basophilia)
3. excessive bleeding caused by hereditary lack of blood clo ing factors
4. excessive iron deposits throughout the body
5. malignant neoplasm of bone marrow
6. infectious disease marked by increased numbers of mononuclear
leukocytes and enlarged cervical lymph nodes
K
1. E
2. G
3. J
4. B
5. D
6. A
7. H
8. C
9. F
10. I
L
1. red blood cell morphology
2. hematocrit
3. platelet count
4. erythrocyte sedimentation rate
5. white blood cell differential
6. antiglobulin (Coombs) test
7. hematopoietic stem cell transplantation
8. bone marrow biopsy
884
9. red blood cell count
10. autologous transfusion
M
1. sickle cell anemia
2. white blood cell
3. prothrombin time
4. multiple myeloma
5. hemophilia
6. aplastic anemia
7. mononucleosis
8. menorrhagia; iron deficiency anemia
9. hematologic; eosinophilia
10. pancytopenia; hypoplasia
N
1. hemoglobin: A
2. graft-versus-host disease: G
3. acute lymphoid leukemia: C
4. prothrombin time: D
5. chronic myeloid (myelocytic) leukemia: F
6. erythropoietin: J
7. immunoglobulins: H
8. chronic lymphoid leukemia: I
9. hematocrit: E
10. acute myeloid (myelocytic) leukemia: B
Answers to Practical Applications
Case Report
1. c
2. b
3. a
885
4. d
Five Short Clinical Cases
1. c
2. b
3. c
4. b
5. a
Pronunciation of Terms
The terms you have learned in this chapter are presented here with their pronunciations.
The meanings for all the terms are in the Mini-Dictionary beginning on page 897. You can
also hear each term pronounced on the Evolve website
(h p://evolve.elsevier.com/Chabner/language/).
Vocabulary and Terminology
886
TERM
albumin
anisocytosis
antibody
anticoagulant
antigen
basophil
bilirubin
coagulation
coagulopathy
colony-stimulating factor
cytology
differentiation
electrophoresis
eosinophil
eosinophilia
erythroblast
erythrocyte
erythropoiesis
erythropoietin
fibrin
fibrinogen
globulin
granulocyte
granulocytopenia
hematopoiesis
hematopoietic stem cell
hemoglobin
hemoglobinopathy
hemolysis
hemostasis
heparin
hypochromic
immune reaction
immunoglobulin
leukapheresis
leukocyte
leukopenia
lymphocyte
lymphoid
macrocytosis
macrophage
megakaryocyte
microcytosis
monoblast
monocyte
mononuclear
morphology
myeloblast
myelodysplasia
myeloid
myelopoiesis
neutropenia
neutrophil
neutrophilia
pancytopenia
phagocyte
plasma
plasmapheresis
platelet
plateletpheresis
poikilocytosis
polymorphonuclear
prothrombin
reticulocyte
Rh factor
serum
PRONUNCIATION
al-BU-min
an-i-so-si-TO-sis
AN-tih-bod-e
an-tih-ko-AG-u-lant
AN-tih-jen
BA-so-fil
bil-ih-RU-bin
ko-ag-u-LA-shun
ko-ag-u-LOP-ah-the
KOL-o-ne STIM-u-la-ting FAK-tor
si-TOL-o-je
dif-er-en-she-A-shun
eh-lek-tro-fo-RE-sis
e-o-SIH-no-fil
e-o-sih-no-FIL-e-ah
eh-RITH-ro-blast
eh-RITH-ro-site
eh-rith-ro-poy-E-sis
eh-rith-ro-PO-eh-tin
FI-brin
fi-BRIN-o-jen
GLOB-u-lin
GRAN-u-lo-site
gran-u-lo-si-to-PE-ne-ah
he-mah-to-poy-E-sis
he-mah-to-poy-EH-tik stem sel
HE-mo-glo-bin
he-mo-glo-bin-OP-ah-the
he-MOL-ih-sis
he-mo-STA-sis
HEP-ah-rin
hi-po-KRO-mik
im-MEWN re-AK-shun
im-u-no-GLOB-u-lin
lu-kah-feh-RE-sis
LU-ko-site
lu-ko-PE-ne-ah
LIMF-o-site
LIMF-oyd
mak-ro-si-TO-sis
MAK-ro-fayg
meg-ah-KAR-e-o-site
mi-kro-si-TO-sis
MON-o-blast
MON-o-site
mon-o-NU-kle-ar
mor-FOL-o-je
MI-eh-lo-blast
mi-eh-lo-dis-PLA-ze-ah
MI-eh-loyd
mi-eh-lo-poy-E-sis
nu-tro-PE-ne-ah
NU-tro-fil
nu-tro-FIL-e-ah
pan-si-to-PE-ne-ah
FA-go-site
PLAZ-mah
plaz-mah-feh-RE-sis
PLAYT-let
playt-let-feh-RE-sis
poy-kih-lo-si-TO-sis
pol-e-mor-fo-NU-kle-ar
pro-THROM-bin
reh-TIK-u-lo-site
R-h FAK-tor
SER-um
887
TERM
sideropenia
spherocytosis
stem cell
thrombin
thrombocyte
thrombocytopenia
thrombolytic therapy
thrombosis
PRONUNCIATION
si-der-o-PE-ne-ah
sfer-o-si-TO-sis
STEM sel
THROM-bin
THROM-bo-site
throm-bo-si-to-PE-ne-ah
throm-bo-LIH-tik THER-ah-pe
throm-BO-sis
Pathology, Laboratory Tests, and Clinical Procedures
TERM
acute lymphoid leukemia
acute myeloid leukemia
anemia
antiglobulin test
apheresis
aplastic anemia
autologous transfusion
blood transfusion
bone marrow biopsy
chronic lymphoid leukemia
chronic myeloid leukemia
complete blood count
dyscrasia
ecchymoses
erythrocyte sedimentation rate
granulocytosis
hematocrit
hematopoietic stem cell transplant
hemochromatosis
hemoglobin test
hemolytic anemia
hemophilia
intrinsic factor
leukemia
mononucleosis
multiple myeloma
palliative
pernicious anemia
petechiae
platelet count
polycythemia vera
prothrombin time
purpura
red blood cell count
red blood cell morphology
relapse
remission
sickle cell anemia
thalassemia
white blood cell count
white blood cell differential
PRONUNCIATION
uh-KYOOT LIMF-oyd lu-KE-me-ah
uh-KYOOT MI-eh-loyd lu-KE-me-ah
ah-NE-me-ah
an-te-GLOB-u-lin test
ah-feh-RE-sis
a-PLAS-tik ah-NE-me-ah
aw-TOL-o-gus trans-FU-zhun
blud trans-FU-zhun
bone MAH-ro BI-op-se
KRON-ik LIM-foyd lu-KE-me-ah
KRO-nik MI-eh-loyd lu-KE-me-ah
kom-PLEET blud kownt
dis-KRA-ze-ah
ek-kih-MO-seez
eh-RITH-ro-site sed-ih-men-TA-shun rate
gran-u-lo-si-TO-sis
he-MAT-o-krit
he-mah-to-poy-E-tik stem sel TRANS-plant
he-mo-kro-mah-TO-sis
HE-mo-glo-bin test
he-mo-LIH-tik ah-NE-me-ah
he-mo-FIL-e-ah
in-TRIN-sik FAK-tor
lu-KE-me-ah
mon-o-nu-kle-O-sis
MUL-tih-pel mi-eh-LO-mah
PAH-le-ah-tiv
per-NIH-shus ah-NE-me-uh
peh-TE-ke-i
PLAT-let kownt
pol-e-si-THE-me-ah VER-ah
pro-THROM-bin time
PUR-pur-ah
red blud sel kownt
red blud sel mor-FOL-o-je
RE-laps
re-MIH-shun
SIK-el sel ah-NE-me-uh
thal-ah-SE-me-ah
wite blud sel kownt
wite blud sel dif-er-EN-shul
Review Sheet
Write the meanings of the word parts in the spaces provided. Check your answers with the
information in the chapter or in the Glossary (Medical Word Parts—English) at the end of
the book.
Combining Forms
888
COMBINING FORM
bas/o
chrom/o
coagul/o
cyt/o
eosin/o
erythr/o
fibrin/o
granul/o
hem/o
hemat/o
hemoglobin/o
is/o
leuk/o
kary/o
mon/o
morph/o
myel/o
neutr/o
nucle/o
phag/o
poikil/o
sider/o
spher/o
thromb/o
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Suffixes
SUFFIX
-apheresis
-blast
-cytosis
-emia
-gen
-globin
-globulin
-lytic
-oid
-osis
-penia
-phage
-philia
-phoresis
-plasia
-poiesis
-stasis
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Prefixes
PREFIX
a-, anantihypomacromegamicromonopanpoly-
MEANING
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Components of blood: Study Figure 13-7, page 479, and fill in the blank boxes.
889
890
CHAPTER 14
891
Lymphatic and Immune Systems
CHAPTER SECTIONS
Introduction 514
Lymphatic System 516
Immune System 519
Vocabulary 522
Terminology 524
Pathology Conditions 525
Laboratory Tests and Clinical Procedures 530
Abbreviations 531
In Person: Hodgkin Lymphoma 532
Practical Applications 533
In Person: Lymphoma Treatment 534
Exercises 535
Answers to Exercises 539
Pronunciation of Terms 540
Review Sheet 542
CHAPTER GOALS
• Identify the structures of the lymphatic and immune systems and understand how the
systems work.
• Learn basic terminology, combining forms, and other word parts related to these systems.
• Recognize terms describing pathologic conditions involving components of the lymphatic and
immune systems.
• Identify laboratory tests, clinical procedures, and abbreviations relating to the lymphatic and
immune systems.
• Apply your new knowledge to understanding medical terms in their proper contexts, such as
medical reports and records.
892
893
Introduction
The lymphatic system and the immune system are considered together in this chapter
because aspects of their functions in the body are very closely related.
Lymph is a clear, watery fluid that surrounds body cells and flows in a system of
thin-walled lymph vessels (the lymphatic system) that extends throughout the body.
Lymph differs from blood, but it has a close relationship to the blood system. Lymph
fluid does not contain erythrocytes or platelets, but it is rich in two types of white blood
cells (leukocytes): lymphocytes and monocytes. The liquid part of lymph is similar to
blood plasma in that it contains water, salts, sugar, and wastes of metabolism such as
urea and creatinine, but it differs in that it contains less protein. Lymph actually
originates from the blood. It is the same fluid that filters out of tiny blood capillaries
into the spaces between cells. This fluid that surrounds body cells is called interstitial
fluid. Interstitial fluid passes continuously into specialized thin-walled vessels called
lymph capillaries, which are found coursing through tissue spaces (Figure 14-1). The
fluid in the lymph capillaries, now called lymph instead of interstitial fluid, passes
through larger lymphatic vessels and through clusters of lymph tissues (lymph nodes),
finally reaching large lymphatic vessels in the upper chest. Lymph enters these large
lymphatic vessels, which then empty into the bloodstream. Figure 14-2 illustrates
schematically the relationship between the blood and the lymphatic systems. Table 14-1
reviews the differences between lymph and blood.
FIGURE 14-1 Interstitial fluid and lymph capillaries.
894
FIGURE 14-2 Relationship between the circulatory systems of blood and
lymph. Start at tissue cells (1) and follow the green arrows which show the flow of
lymph into the bloodstream via veins (5).
TABLE 14-1
LYMPH AND BLOOD
LYMPH (colorless)
NO PUMP
Fluid moved along by muscle movement and valves
WHITE BLOOD CELLS
Lymphocytes
Monocytes
INTERSTITIAL FLUID
Water
Less protein and other plasma components
Lipids (fats) from small intestine
BLOOD (red)
PUMP
Heart pumps blood through blood vessels
ALL BLOOD CELLS
Erythrocytes (give blood its red color)
Leukocytes
Platelets
PLASMA
Water
Proteins
Salts, nutrients, lipids, and wastes
The lymphatic system has several functions. First, it is a drainage system to transport
needed proteins and fluid that have leaked out of the blood capillaries (and into the
interstitial fluid) back to the bloodstream via the veins. Second, the lymphatic vessels in
the intestines absorb lipids (fats) from the small intestine and transport them to the
bloodstream.
A third function of the lymphatic system relates to the immune system: the defense
of the body against foreign organisms such as bacteria and viruses. Lymphocytes and
monocytes, originating in bone marrow, lymph nodes, and organs such as the spleen
and thymus gland, protect the body by producing antibodies and by mounting a
cellular a ack on foreign cells and organisms.
895
Lymphatic System
Anatomy
Label Figure 14-3A as you read the following paragraphs.
FIGURE 14-3 Lymphatic system. A, Label the figure according to the descriptions
in the text. B, Note the different regions of the body drained by the right
lymphatic duct and the thoracic duct.
Lymph capillaries [1] begin at the spaces around cells throughout the body. Like
blood capillaries, they are thin-walled tubes. Lymph capillaries carry lymph from the
tissue spaces to larger lymph vessels [2]. Lymph vessels have thicker walls than those of
lymph capillaries and, like veins, contain valves so that lymph flows in only one
direction, toward the thoracic cavity. Collections of stationary lymph tissue, called
lymph nodes [3], are located along the path of the lymph vessels.
Major sites of lymph node concentration are shown in Figure 14-3A. These are the
cervical (neck) [4], axillary (armpit) [5], mediastinal (chest) [6], mesenteric (intestinal)
[7], paraaortic (lumbar) [8], and inguinal (groin) [9] regions. Remember that tonsils are
masses of lymph tissue in the throat near the back of the mouth (oropharynx), and
896
adenoids are enlarged lymph tissue in the part of the throat near the nasal passages
(nasopharynx).
Lymph vessels all lead toward the thoracic cavity and empty into two large ducts in
the upper chest. These are the right lymphatic duct [10] and the thoracic duct [11]. The
thoracic duct drains the lower body and the left side of the head, whereas the right
lymphatic duct drains the right side of the head and the chest (a much smaller area) (see
Figure 14-3B). Both ducts carry the lymph into large veins [12] in the neck, where the
lymph then enters the bloodstream.
Lymph nodes not only produce lymphocytes but also filter lymph and trap
substances from infectious, inflammatory, and cancerous lesions. Special cells called
macrophages, located in lymph nodes (as well as in the spleen, liver, and lungs),
swallow (phagocytose) foreign substances. When bacteria are present in lymph nodes
that drain a particular area of the body, the nodes become swollen with collections of
cells and their engulfed debris and become tender . Lymph nodes also fight disease
when specialized lymphocytes called B lymphocytes (B cells), which are present in the
nodes, produce antibodies. Other lymphocytes present in nodes are T lymphocytes (T
cells). They a ack bacteria and foreign cells by accurately recognizing a cell as foreign
and destroying it. T cells also help B cells make antibodies. See Figure 14-4 for an
illustration of a lymph node. B cells mature in bone marrow, whereas T cells originate in
the thymus gland.
FIGURE 14-4 Lymph node containing lymphocytes (B cells and T cells) and
macrophages.
Lymph Nodes and Tenderness
Tenderness is related to the speed of swelling of the lymph node and the stretching of
the node capsule. More slowly expanding nodes, such as those involved with tumors,
are usually non-tender. Tenderness tends to indicate an inflammatory rather than
cancerous origin.
897
Spleen and Thymus Gland
The spleen and the thymus gland are specialized organs that also are a part of the
lymphatic system.
The spleen (Figure 14-5A) is located in the left upper quadrant of the abdomen, next
to the stomach. Although the spleen is not essential to life, it has several important
functions:
FIGURE 14-5 A, Spleen and adjacent structures. B, Thymus gland in its location
in the mediastinum between the lungs.
1. Destruction of old erythrocytes by macrophages. In the slow-moving
circulation of the spleen, red cell breakdown liberates hemoglobin, which is
converted to bilirubin in the liver and then is excreted into the bile.
2. Filtration of microorganisms and other foreign material from the blood.
3. Activation of lymphocytes. Activated B lymphocytes (B cells) produce
antibodies. Activated T lymphocytes (T cells) a ack foreign materials.
4. Storage of blood, especially erythrocytes and platelets.
The spleen is susceptible to injury. A sharp blow to the upper abdomen (as from the
impact of a car's steering wheel) may cause rupture of the spleen. Massive hemorrhage
can occur when the spleen is ruptured, and immediate surgical removal (splenectomy)
may be necessary. After splenectomy, the liver, bone marrow, and lymph nodes take
over the functions of the spleen.
The thymus gland (see Figure 14-5B) is a lymphatic organ located in the upper
mediastinum between the lungs. During fetal life and childhood it is quite large, but it
becomes smaller with age. The thymus gland is composed of nests of lymphoid cells
resting on a platform of connective tissue. It plays an important role in the body's ability
to protect itself from disease (immunity), especially in fetal life and during the early
years of growth. It is known that a thymectomy (removal of the thymus gland)
performed in an animal during the first weeks of life impairs the ability of the animal to
make antibodies and to produce immune cells that fight against foreign antigens such as
bacteria and viruses. Thus, the thymus gland is important in development of an
effective immune system in childhood.
Early in development, in the thymus, lymphocytes learn to recognize and accept the
body's own antigens as “self” or friendly. This acceptance of “self” antigens is called
tolerance. When the tolerance process fails, immune cells react against normal cells,
resulting in various pathologic conditions (autoimmune disease). See page 524, under
autoimmune disease (aut/o = self).
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Immune System
The immune system is specialized to defend the body against antigens (such as toxins,
bacterial proteins, or foreign blood cells). This system includes leukocytes such as
neutrophils, monocytes, and macrophages, which are phagocytes found in blood and
tissues throughout the body. In addition, lymphoid organs, such as the lymph nodes,
spleen, thymus gland, tonsils, and adenoids, produce lymphocytes and antibodies.
Natural and A